Biologics mitigate risk for venous thromboembolism in RA
TNF inhibitors bested conventional disease-modifying antirheumatic drugs at reducing venous thromboembolic events in patients with rheumatoid arthritis, according to data presented at the EULAR 2020 E-Congress.
“If you read the press, you will often read about heart disease and cancer and COVID, because these are emotional diseases that lead to severe illness and death,” John Isaacs, PhD, MBBS, EULAR Scientific Committee Chair, said in his presentation. “As rheumatologists, we see our own diseases get overlooked.”
Isaacs, who also serves as director of therapeutics North East at Newcastle University and director of research at Newcastle upon Tyne Hospitals in the U.K., added that patients with rheumatic diseases bear a significant comorbidity burden, including heart attacks, strokes and other cardiovascular outcomes, that could take 7 to 10 years off of their lives.
“But RA was not on the death certificate,” Isaacs said. Rather, the cardiovascular event would be noted as the cause of death.
It is for this reason that venous thromboembolism ended up on the radar of rheumatology researchers. Blood clots begin in the extremities and can end up in the heart or lungs. “Half of patients will die if they get this,” Isaacs said.
“We have known for a while that venous thromboembolism is more common in RA, at least three times as common as the general population, maybe more,” Isaacs said.
Isaacs then reviewed some key data sets outlining these associations.
The first was from a Swedish cohort suggesting that as many as one in 100 individuals with RA who have high disease activity may experience a thrombotic event. The analysis included more than 46,000 patients who were followed for 12 years. Disease Activity Score (DAS) 28 served as the assessment tool.
“What they found is a dose response, if you will, between venous thromboembolism and high disease activity,” Isaacs said, and acknowledged the importance of the result that one in 100 RA patients will have such an event: “If you consider that half those patients will die, that is pretty significant.”
Turning to the German RABBIT1 registry, Isaacs addressed the potential impact of RA therapies on thrombosis risk. The German group analyzed data for more than 11,000 patients treated with either conventional synthetic disease-modifying antirheumatic drugs (csDMARD) such as methotrexate, sulfasalazine and leflunomide, or biologic therapies such as adalimumab (Humira, Abbvie), certolizumab pegol (Cimzia, UCB), etanercept (Enbrel, Amgen), golimumab (Simponi, Janssen) and infliximab (Remicade, Janssen).
Results of RABBIT1 showed that TNF inhibitors nearly halved major venous thromboembolism risk compared with csDMARDs.
“IL-6 inhibitors also probably have a similar effect, but the study was not powered for this,” Isaacs said. “But it showed that biologics are better than traditional drugs [at reducing thromboembolic events]. This is probably because they are better at reducing inflammation.”
Other findings showed that an increase in inflammatory activity also correlated with a significant increase in venous thromboembolism risk. That risk approximately doubled the thromboembolism risk associated with a CRP value of at least 5 mg/L, according to the findings.
Isaacs suggested that the rheumatology community should take note of these findings for one key reason: “Prolonging the lives of our patients,” he said.
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Isaacs J. Thrombosis risk particularly high for people suffering from rheumatism with high inflammatory values – Reduced venous thrombosis with TNF inhibitors. Presented at: EULAR 2020 E-Congress; June 3-6, 2020 (virtual meeting).
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