Subsequent Cardiovascular Events Among Patients with Rheumatoid Arthritis, Psoriatic Arthritis, or Psoriasis: Patterns of Disease-Modifying Antirheumatic Drug Treatment.

OBJECTIVE

To examine disease-modifying antirheumatic drug (DMARD) treatments and estimate risk of a subsequent cardiovascular (CV) event following an initial CV event in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO).

METHODS

We analyzed data from MarketScan® claims databases (1/1/2006-6/30/2015) for adults with RA, PsA, or PsO and initial/index CV event (acute myocardial infarction, stroke, or coronary revascularization) while receiving DMARDs (tumor necrosis factor inhibitor [TNFi] biologic DMARDs [bDMARDs], conventional synthetic DMARDs [csDMARDs], or non-TNFi bDMARDs). We studied DMARD treatment patterns following index event and rates of subsequent CV events. We used Cox regression to investigate predictors of DMARD discontinuation and risk factors for subsequent CV events.

RESULTS

Among 10,254 patients, 15.3% discontinued and 15.5% switched DMARD therapy after index CV event. Independent predictors of DMARD discontinuation included PsO diagnosis, renal disease, hypertension, heart failure, diabetes mellitus, older age, and baseline csDMARD or non-TNFi bDMARD use (vs TNFi bDMARDs). Rates per 1,000 patient-years (95% confidence interval) of subsequent events were 75.2 (54.4-96.0) for patients on TNFi bDMARDs, 83.6 (53.3-113.9) for csDMARDs, and 122.4 (60.6-184.3) for non-TNFi bDMARDs. RA diagnosis (vs PsO) and heart failure at baseline, but not DMARD pattern after index event, were independently associated with increased risk of subsequent CV event.

CONCLUSIONS

In this large nationwide study, nearly one-third of patients with RA, PsA, or PsO switched or discontinued DMARD therapy following a CV event. There was no association between DMARD class and risk of subsequent CV event. This article is protected by copyright. All rights reserved.