This article is more than 5 years old. Information may no longer be current.
Tocilizumab's CV Risk Comparable to That of Etanercept, Other RA Biologics
Click Here to Manage Email Alerts
The risk for cardiovascular disease associated with tocilizumab is comparable to that of etanercept, as well as several other biologics used to treat rheumatoid arthritis, according to findings published in Arthritis Care & Research.
“Some biologics appear to reduce cardiovascular disease risk — for example, heart attack — in rheumatoid arthritis, but it is not clear if it’s equally true of all biologics, or whether some biologics’ mechanisms of action might have a more or less favorable effect on said disease risk,” Jeffrey Curtis, MD, MS, MPH, of the University of Alabama at Birmingham, told Healio Rheumatology. “Moreover, IL-6R drugs such as tocilizumab numerically increase lipids, but it is not clear if this has an adverse effect on cardiovascular disease risk or not.”
To determine the risk for cardiovascular disease associated with tocilizumab (Actemra, Genentech) compared with a variety of other biologic RA treatments — including etanercept (Enbrel, Amgen), rituximab (Rituxan, Genentech) and abatacept (Orencia, Bristol Myers Squibb) — the researchers conducted a retrospective cohort study using claims data from MarketScan and Medicare.
Analyzing data from Jan. 1, 2006, to Sept. 30, 2015, the researchers identified and included in their study 88,463 patients with RA who began treatment with a disease-modifying antirheumatic drug after the start of 2010. The primary outcomes were myocardial infarction, stroke and fatal cardiovascular disease. The researchers evaluated RA disease activity as a potential confounder in a subgroup analysis including 5% to 10% of biologic initiations, using the multibiomarker disease activity score.
According to the researchers, the crude incidence rate for composite CVD among patients insured through Medicare ranged from 11.8 per 1,000 patientyears (95% CI, 9.714.4) for those treated with etanercept, to 17.3 (95% CI, 15.219.7) for rituximab users. In addition, the rate for pooled TNF inhibitor users was 15 per 1,000 patient-years (95% CI, 13.916.3). Compared with tocilizumab, the adjusted HRs were 1.01 (95% CI, 0.791.28) for abatacept; 1.16 (95% CI, 0.891.53) for rituximab; 1.1 (95% CI, 0.81.51) for etanercept; 1.33 (95% CI, 0.991.8) for adalimumab (Humira, AbbVie); and 1.61 (95% CI, 1.222.12) for infliximab (Remicade, Janssen).
Based on MarketScan data, the researchers reported no statistically significant differences in the risk for CVD between tocilizumab and any other biologic treatment. These results were robust in many subgroup evaluations, according to the researchers, as well as after external adjustment to control for RA disease activity in the subgroup of 4,156 patients with linked multibiomarker disease activity test results.
“While clinicians may not be explicitly selecting a biologic drug in RA based on its cardiovascular safety profile, it is reassuring that our newest biologic drug class, IL-6R therapies, do not increase cardiovascular disease risk and, if anything, seem to be at the lower end of risk compared to other biologic therapies for RA,” Curtis said. “From a more clinical perspective, patients worry a great deal about biologic safety, and I put their reduced cardiovascular disease risk in the ‘good side effect’ category for patients, such that if we can get systematic inflammation under control, they likely reduce their risk.” – by Jason Laday
Disclosure: Curtis reports research grants and consulting fees from Amgen, AbbVie, BMS, Corrona, Janssen, Lilly, Myriad, Pfizer, Roche and UCB. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts