RESEARCH - Reduction in the incidence of myocardial infarction in patients with RA who respond to anti-TNF therapy: BSRBR

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Arthritis Rheum. 2007 September; 56(9): 2905-2912.

doi: 10.1002/art.22809. PMCID: PMC2435427

Reduction in the incidence of myocardial infarction in patients with

rheumatoid arthritis who respond to anti-tumor necrosis factor á

therapy: Results from the British Society for Rheumatology Biologics

Register

W G Dixon, K D , M Lunt, K L Hyrich, A J Silman, and D P M

Symmons, on behalf of the British Society for Rheumatology Biologics

Register

University of Manchester, Manchester, UK

British Society for Rheumatology Biologics Register Control Centre Consortium

Dr. Hyrich is a former Fellow of the Canadian Arthritis Society. Drs.

Symmons and Silman's work was supported by the Arthritis Research

Campaign, UK. The British Society for Rheumatology Biologics Register

is supported by a research grant from the British Society for

Rheumatology to the University of Manchester, which is indirectly

funded by Schering-Plough, Wyeth Laboratories, Abbott Laboratories,

and Amgen.

Objective

Rheumatoid arthritis (RA) is associated with an increased risk of

coronary artery disease, possibly acting via shared mechanisms of

inflammation. This study was undertaken to test the hypothesis that

the powerful antiinflammatory effect of anti-tumor necrosis á

(anti-TNFá) therapy might lead to a reduction in the incidence of

myocardial infarction (MI) in patients with RA.

Methods

Using data from the British Society for Rheumatology Biologics

Register, a national prospective observational study, we compared MI

rates in 8,670 patients with RA treated with anti-TNFá and 2,170

patients with active RA treated with traditional disease-modifying

antirheumatic drugs (DMARDs).

Results

Through July 2006, 63 MIs occurred in the anti-TNFá cohort during

13,233 person-years of followup and 17 MIs occurred in the DMARD

cohort during 2,893 person-years of followup, equivalent to a rate of

4.8 events per 1,000 person-years and 5.9 events per 1,000

person-years, respectively. After adjustment for baseline risk

factors, there was no reduction in the rate of MI in the anti-TNFá

cohort compared with the DMARD cohort (incidence rate ratio 1.44 [95%

confidence interval 0.56-3.67]). In an analysis of anti-TNFá-treated

patients who responded to the treatment within 6 months versus those

who did not, MI rates were found to be 3.5 events per 1,000

person-years in responders and 9.4 events per 1,000 person-years in

nonresponders. The adjusted incidence rate ratio (95% confidence

interval) for responders compared with nonresponders was 0.36

(0.19-0.69).

Conclusion

These results indicate that RA patients treated with anti-TNFá do not

have a lower incidence of MI compared with RA patients treated with

traditional DMARDs. However, the risk of MI is markedly reduced in

those who respond to anti-TNFá therapy by 6 months compared with

nonresponders. This finding supports the notion that inflammation

plays a pivotal role in MI.

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Read the full article here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435427

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