Adverse Cardiovascular Events in Patients with Rheumatic Conditions and Biologic Therapy Interruption

Abstract

Background: Recent studies in patients with rheumatologic conditions support the importance of inflammation in the development of atherosclerosis. Moreover, targeting inflammation upstream with biological agents for atherosclerosis progression has become the focus of intense research. Whilst biologics suppress inflammation, they increase serious infection (SI) risk. We hypothesised that biologic therapy interruption due to SI in patients would lead to rebound inflammation and more major adverse cardiovascular events (MACE) compared to those with no interruption. Methods: We retrospectively analysed a cohort of 265 patients above the age 18 who received biologics for rheumatoid arthritis; ankylosing spondylitis; and psoriatic arthritis with regular follow-ups. Patient characteristics, biologic therapy interruptions, SIs and MACE (non-fatal MI, non-fatal stroke and cardiovascular death) were captured in detail. Patients were categorised into 3 groups for analysis: (1) pause AND SI, (2) pause AND no SI, and (3) no pause. Results: Baseline characteristics were similar between the groups. A total of 357 pauses in biologic therapy was noted among 152 patients, of which 39 (11%) were observed in 25 patients due to SI. A significantly higher rate of MACE was observed in the group who paused for SI compared to others (Figure). Also, whilst pausing biologic therapy due to SI was associated with an increased incremental odds of experiencing MACE [OR 4.08 (95% CI 1.21–13.74), p = 0.023], pausing biologics for other reasons was not [OR 1.17 (95% CI 0.41–3.29), p = 0.77].Conclusions: In rheumatic patients, biologic therapy interruption due to SI leads to increased MACEs.