RA: TNF-inhibitor-methotrexate Therapy is Associated with Reduction of Heart Attack Risk
After writing the other week about the depressing research related to mortality rates of RA sufferers and the link to cardiovascular problems, I was pleased to see reports of another study with more positive news for people with RA. Research presented recently at the American College of Rheumatology Annual Scientific Meeting shows that the use of combination TNF-inhibitor-methotrexate therapy in people with RA is associated with an 80% reduction in the risk of heart attack compared with patients taking methotrexate alone.
It has been well documented that people with RA are at a higher risk of heart attacks and other cardiovascular events like strokes, because of inflammation throughout the body. This inflammation not only affects joints, but can also affect internal organs and the coronary vessels, the latter resulting in the increase risk of heart attacks.
Researchers recently studied the risk of heart attack in patients using a TNF-inhibitor, methotrexate and other DMARDs in a large population of patients with RA. Many of the study participants also were taking aspirin. The researchers used data from the California Medicaid Program to study patients over a period of 6.5 years.
A total of 19,233 patients with RA were identified through the data used. Patients averaged 55 years of age, and most (almost 80%) were women. These numbers are fairly typical of RA sufferers, since it disproportionately affects women and most adult women who develop RA are over 35. In this study, 13,383 patients took methotrexate; 14,958 took other DMARDS; and 4,943 took TNF-inhibitors. Usage of TNF-inhibitors (taken alone or in combination with methotrexate) was compared to taking methotrexate alone.
During the study period, 441 patients out of the 19,233 suffered heart attacks. Eight percent (or 35 of the heart attacks) were fatal. Researchers found that patients on a combination of TNF-inhibitors with methotrexate treatment had the least risk of heart attacks among the groups in the study. Their risk for a heart attack was only 20 percent compared to patients taking methotrexate alone. Unfortunately for patients, no other single drug or combination of RA drugs had this great of a decrease in risk. The researchers found no statistical difference among patients who were taking only TNF-inhibitors, TNF-inhibitors in combination with other DMARDs, DMARD therapies in combination with methotrexate, or methotrexate alone.
I was unable to locate the actual presentation abstract to determine if a specific TNF-inhibitor was responsible for the positive results, but I will keep looking. This article should be encouraging for people with RA, especially those like me who have family/genetic risk factors or other risk factors.