Patients with AS who start TNF inhibition early have higher cardiovascular risk
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PHILADELPHIA — Patients who started TNF inhibitors earlier in their ankylosing spondyloarthritis disease course, vs. no initiation, have a higher risk for cardiovascular events, according to data presented at ACR Convergence 2022.
“We really wanted to tackle two major issues with this study,” Jean Liew, MD, an assistant professor of medicine and a rheumatologist at Boston University, said during a press conference. “The first is that we know there is an increase of cardiovascular disease burden in people with AS.”
To investigate the correlation between early TNF-inhibitor use in AS and cardiovascular disease outcomes, Liew and colleagues analyzed a cohort of patients from the Veterans Affairs Corporate Data Warehouse. The researchers collected data between 2002 and 2019. For the purposes of the analysis, Liew and colleagues defined AS as one or more inpatient, or two or more outpatient, diagnosis codes with at least 6 weeks between them. The researchers determined any TNF-inhibitor use via pharmacy dispense and infusion data. Meanwhile, early TNF-inhibitor use was defined as exposure during the 12-month period following the index date.
The primary outcome was the occurrence of any incident cardiovascular disease, including coronary artery disease, myocardial infarction or ischemic stroke. Secondary outcomes included myocardial infarction, venous thromboembolism, stroke, major adverse cardiovascular events (MACE) and all-cause mortality. Follow-up began 12 months after the disease index date and lasted until a cardiovascular event, death, disenrollment or the end of the study period.
The analysis included 17,666 patients with incident AS diagnosis during the study period. Of these patients, 2,321 started TNF inhibitors early in their disease course while 15,345 did not initiate at all. During the follow-up period, 15.1% of patients who started TNF inhibitors demonstrated an incident cardiovascular disease event, compared with 19.7% of those did not initiate.
In the propensity score analysis, early TNF inhibition correlated with higher risks for incident cardiovascular disease (HR = 1.17; 95% CI, 1.01-1.35), stroke (HR = 1.24; 95% CI, 1.03-1.5) and MACE (HR = 1.22; 95% CI, 1.03-1.45), according to the researchers.
“Although there is an apparent increased risk of cardiovascular disease, this could still be reflective of residual confounding — particularly confounding by indication — which you can’t fully exclude,” Liew said. “Although we have used this novel, innovative approach to identify an AS cohort, our results are still limited by potential biases that are not overcome by using this phenotyping algorithm.”
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Liew J. Abstract 0415. Presented at: ACR Convergence 2022; Nov. 11-15, 2022; Philadelphia (hybrid meeting).
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