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No evidence of increased cardiovascular risk with tocilizumab vs TNF inhibitors
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Researchers from Brigham and Women’s Hospital found no evidence of an increased cardiovascular risk among patients who took tocilizumab vs. patients who took tumor necrosis factor inhibitors.
“Since [rheumatoid arthritis] RA patients have a nearly two-fold increased risk of cardiovascular disease and cardiovascular mortality compared with the general population, increases in [low-density lipoprotein] LDL cholesterol levels with [tocilizumab] TCZ have been a concern,” Seoyoung C. Kim, MD, ScD, MSCE, from Brigham and Women’s Hospital, and colleagues wrote. “In this large U.S. population-based multidatabase cohort study of 28,028 patients with RA who had previously received at least one biologic drug, we found no increase in the risk of a composite cardiovascular end point of [myocardial infarction] MI or stroke between TCZ initiators and [tumor necrosis factor inhibitor] TNFi initiators. In fact, we found a numeric decrease in risk and ruled out a risk increase of >26% based on the upper limited of the 95% CI for the combined [hazard ratio] HR.”
Kim and colleagues used three databases to assess 18,810 TNFi initiators and 9,218 TCZ initiators with RA. In total, there were 125 cardiovascular events of MI or stroke. The incidence rate of cardiovascular events was 0.52 per 100 person-years for TCZ and 0.59 per 100 person-years for TNFi initiators. There was a slight, but nonsignificant decreased risk for all-cause death for TCZ vs. TNFi (ratio = 0.84). In addition, there were no significant associations found for acute coronary syndrome, coronary revascularization, heart failure or any cardiovascular event. In the subgroup analyses, there were no significant associations for age, baseline cardiovascular disease, baseline diabetes, concomitant methotrexate, oral steroid use or statin use.
“This study has important clinical implications,” the researchers wrote. “While elevations in lipid levels occur in patients treated with TCZ, such increases do not appear to be associated with an increased risk of clinical cardiovascular events.” – by Will A. Offit
Disclosure: Kim reports research funding from Lilly, Genentech, Pfizer, Bristol-Myers Squib and AstraZeneca.
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