Some RA Meds Tied to Lower Heart Attack Risk Than Others

Rheumatoid arthritis patients taking only TNF inhibitors had lower heart attack rates than those taking only DMARDs

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Rheumatoid arthritis patients have an increased risk for heart attacks. Some medications used to treat the inflammation from arthritis may also help lower the risk of heart attack as well.

A recent study compared the risk of heart attack between rheumatoid arthritis patients taking only anti-TNF medications and those taking only traditional disease-modifying antirheumatic drugs (DMARDs).

Anti-TNFs and DMARDs are two of the main types of medications used to treat rheumatoid arthritis.

This study found that RA patients taking only anti-TNFs had fewer heart attacks than patients taking only DMARDs.

"Ask your doctor about all your medication options."

This study was conducted by William Dixon, MD, MRC, from the Arthritis Research UK Epidemiology Unit at The University of Manchester in the UK, and colleagues.

According to Dr. Dixon, “Better control of inflammation with biologic therapy (anti-TNFs) might reduce not only the rate of heart attacks, but potentially also affect the size of [heart attacks].”

Anti-TNFs focus on reducing inflammation caused by a substance called tumor necrosis factor (TNF). Examples of anti-TNFs include etanercept (brand name Enbrel), infliximab (Remicade) and adalimumab (Humira).

Traditional DMARDs — or non-biologic DMARDs — focus on slowing down the progression of rheumatoid arthritis. Examples of traditional DMARDs include methotrexate (brand name Trexall), leflunomide (Arava), and hydroxychloroquine (Plaquenil).

This study used data from The British Society for Rheumatology Biologics Register (BSRBR-RA) which contains information of approximately 20,000 UK patients using RA medications since 2001. In addition, more detailed information on the type and severity of heart attacks was obtained from another British database — the Myocardial Ischaemia National Audit Project (MINAP).

Using the BSRBR-RA database, the researchers identified 3,058 individuals treated with traditional DMARDs and 11,200 with anti-TNF medications. A total of 58 patients (1.9 percent) on traditional DMARDs and 194 patients (1.7 percent) on anti-TNFs had had a heart attack.

The MINAP database recorded 35 additional heart attacks among RA patients treated with traditional DMARDs and 108 additional heart attacks among patients treated with anti-TNFs.

The researchers estimated that 56 cases of heart attacks would be expected to occur for 10,000 RA patients using traditional DMARDs per year versus 35 heart attacks if patients were using anti-TNFs.

The study also reported that the chances of a heart attack for a patient treated with anti-TNFs were around half (0.61 times) the chances of a patient treated with traditional DMARDs.

The researchers also analyzed the type of heart attack, degree of muscle injury (creatine kinase levels) and hospitalization length to assess the severity of the heart attacks. But no statistical differences were found between the two patient groups.

In conclusion, this study reported a lower number of heart attacks in patients using anti-TNF compared to patients using traditional DMARDs, but no differences in the severity of heart attacks.

A limitation of this study is that the participants only took one DMARD or biologic, whereas many rheumatoid arthritis patients take several.

The authors commented that anti-TNF medications may be effective for reducing heart attacks as wells as to improve joint inflammation.

“Rheumatologists can be reassured that treatment of active rheumatoid arthritis with anti-TNF therapy may lead not just to an improvement in joint symptoms, but also a reduction in the rate of [heart attacks] in the medium term,” said Dr. William Dixon.

This study will be presented on October 29 at the annual meeting of the American College of Rheumatology in San Diego.

Review Date: 
October 25, 2013
Last Updated:
October 27, 2013