MAJOR ADVERSE CARDIOVASCULAR EVENT AND VENOUS THROMBOEMBOLISM RISK COMPARING ADVANCED THERAPIES AMONG INDIVIDUALS WITH AXIAL SPONDYLARTHRITIS AND PSORIATIC ARTHRITIS
Authors: Merjanah S et al.
Patients with inflammatory diseases have an increased cardiovascular risk compared to the general population. In the ORAL Surveillance trial (in RA patients over 50 years with at least one additional cardiovascular risk factor) tofacitinib was shown to be not non-inferior to TNF inhibitors with regard to MACE and malignancies and the discussion of this trial has been ongoing since then. In this analysis, two nested case-control analyses were performed using US insurance claims databases between 2006-2021. Adults with a diagnosis of axSpa or PsA aged 18-65 years were included. MACE was defined as myocardial infarction or stroke/TIA. Cases and controls were matched 1:4 by age, gender and diagnosis and adjusted for various confounders. 1065 MACE cases were identified among 5325 adults with axSpA or PsA and 1554 VTE cases among 7770 axSpA or PsA patients.
Comorbidities such as previous cardiovascular disease, obesity, hypertension or diabetes were more frequent in cases compared to controls. Interestingly, this analysis included non-users of TNFi and JAKi that had a 1.3 times higher risk of MACE relative to TNFi users (95% CI 1.08-1.50). JAKi did not show an increased MACE risk compared to TNFi (OR 0.86, 95%CI 0.37-1.99). There was a trend of a higher VTE rate in JAKi users that was not statistically significant.
This analysis was based on US insurance data to evaluate the risk for MACE and VTE in patients with axSpa or PsA. Of interest, they also included a non-TNF-non-JAKi population in their analysis, the lack of such a control group belongs to the shortcomings of the ORAL Surveillance trial. A trend for more frequent VTEs was confirmed, however, no significant increase of MACE for JAKi users was detected. Of note, the average age of patients and controls was 55 years, with the usual risk factors such as obesity, smoking, chronic kidney disease, previous cardiovascular disease, hypertension, hyperlipidemia and malignancies being more frequently observed among cases compared to controls. Management of cardiovascular risk factors seems critical for this patient population.