The Impact of Newer Biological Disease Modifying Anti-Rheumatic Drugs on Cardiovascular Risk Factors: A 12-Month Longitudinal Study in Rheumatoid Arthritis Patients Treated with Rituximab, Abatacept and Tociliziumab.

Sella Aarrestad Provan,Tore Kristian Kvien,Alexander Mathiessen,Inger Jorid Berg,Anne Grete Semb,Hilde Berner Hammer,Peter Szodoray

doi:10.1371/journal.pone.0130709

Sella Aarrestad Provan, Tore Kristian Kvien + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0130709

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Journal: PloS one	Publication Date: Jun 26, 2015
Citations: 52	License type: CC BY 4.0

Affiliation: Diakonhjemmet Hospital

Abstract

ObjectivesTo assess whether treatment with one of three novel biological DMARDs; rituximab, abatacept or tocilizumab reduce cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA).MethodsThis is an open, observational and prospective study with visits at baseline, 3, 6, and 12 months. Patients were assigned to receive rituximab, abatacept or tocilizumab according to clinical indications assessed by an independent rheumatologist. Disease activity was quantified by the disease activity score (DAS28) and extensive ultrasonography. CVD risk was assessed by total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), blood pressure and arterial stiffness measurements [pulse wave velocity (PWV) and augmentation index (AIx)]. Within group change in disease activity and CVD risk over 3 months was explored using paired samples bivariate tests. Predictors of change in CVD risk at 3 months were identified in linear regression models. Changes in CVD risk markers over the 12- month follow-up in patients receiving rituximab were assessed by mixed models repeated analyses.Results24 patients on rituximab, 5 on abatacept and 7 on tocilizumab were included. At 3 months PWV was significantly reduced in the tocilizumab group only, but at 12 months rituximab patients showed a significant reduction in PWV. Reduced inflammation at 3 months was associated with increased TC and HDL-c in the entire cohort.ConclusionTreatment with tocilizumab and rituximab reduces PWV, a marker of CVD risk, in patients with RA.

Highlights

Clinical disease activity and systemic inflammation are independent predictors of mortality from cardiovascular disease (CVD) in rheumatoid arthritis (RA) [1], and studies have shown that methotrexate and tumour necrosis factor-α inhibitors (TNF-α) therapy can reduce CVD mortality [2]
CVD risk was assessed by total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), blood pressure and arterial stiffness measurements [pulse wave velocity (PWV) and augmentation index (AIx)]
At 3 months Pulse wave velocity (PWV) was significantly reduced in the tocilizumab group only, but at 12 months rituximab

Summary

Introduction

Clinical disease activity and systemic inflammation are independent predictors of mortality from cardiovascular disease (CVD) in rheumatoid arthritis (RA) [1], and studies have shown that methotrexate and tumour necrosis factor-α inhibitors (TNF-α) therapy can reduce CVD mortality [2]. Treatment with TNF-α inhibitors has been shown to improve the level of several CVD risk markers, including PWV and AIx [2,3]. Abatacept and tocilizumab are three biological disease-modifying antirheumatic drugs (DMARD) with proven efficacy in RA [5,6,7]. We hypothesised that these new biological DMARDS would have positive effects on markers of CVD risk

Objectives

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Conclusion