POS0218\u2005TUMOR-NECROSIS FACTOR INHIBITORS IMPROVE AORTIC STIFFNESS IN PATIENTS WITH LONGSTANDING RHEUMATOID ARTHRITIS

Abstract

Major cardiovascular disease (CVD) benefits of disease-modifying anti-rheumatic drugs (DMARDs) therapy occur in early RA patients with treat-to-target strategy. However, it is unknown whether long-term DMARDs treatment in established RA could be useful to improve CVD risk profile.The aim of this study was to comparatively describe aortic stiffness progression in patients with longstanding and established RA treated with tumor necrosis factor inhibitors (TNFi) or conventional synthetic DMARDs (csDMARDs).Ultrasound aortic stiffness index (AoSI) has to be considered a proxy outcome measure in established RA patients. We measured AoSI in a group of RA patients on long-term treatment with TNFi or csDMARDs. Eligible participants were assessed at baseline and after 12 months; changes in serum lipids, glucose and arterial blood pressure were assessed. All patients were on stable medications during the entire follow-up.We included 107 (64 TNFi and 43 csDMARDs) RA patients. Most patients (74%) were in remission or low disease activity and had some CVD risk factors (45.8% hypertension, 59.8% dyslipidemia, 45.3% smoking; table 1). The two groups did not differ significantly for baseline AoSI (5.95±3.73% vs 6.08±4.20%, p=0.867). Follow-up AoSI was significantly increased from baseline in the csDMARDs group (+1.00%; p<0.0001) but not in the TNFi group (+0.15%, p=0.477). Patients on TNFi had significantly lower follow-up AoSI from baseline than the csDMARDs group (-1.02%, p<0.001; ANCOVA corrected for baseline AoSI, age and systolic blood pressure). Furthermore, follow-up AoSI was significantly lower in TNFi users with 1-2 or >2 CVD risk factors than in those without (figure 1).Long-term treatment with TNFi was associated with reduced aortic stiffness in patients with established RA and several CVD risk factors.Baseline characteristics of the study population.csDMARDs(n=43)TNFi(n=64)P valueAge, median years (IQR)58.6 (53.0, 66.0)58.1 (49.3, 67.0)0.839Female sex33 (76.7)54 (84.4)0.321Obesity5 (11.6)7 (10.9)0.999Hypertension19 (44.2)30 (46.9)0.784Anti-hypertensive drug17 (39.5)28 (43.8)0.784Smoking status, ever18 (42.9)30 (46.9)0.684Dyslipidemia30 (40.2)34 (59.8)0.085Current statin use13 (34.2)10 (15.9)0.033Diabetes mellitus3 (7.0)3 (4.7)0.676Anti-diabetic medication1 (2.3)1 (1.5)0.999CVD risk factors, median (IQR)2 (1, 3)2 (1, 3)0.199RF and/or ACPA positive28 (65.1)33 (51.6)0.165Disease duration, median years (IQR)14.1 (11.5)15.4 (10.5)0.538Methotrexate38 (88.4)52 (81.3)0.192Leflunomide5 (17.9)12 (19.0)0.999Hydroxychloroquine9 (31.0)5 (7.8)0.009Prednisone > 5\u2009mg daily7 (7.7)5 (5.5)0.823NSAIDs6 (20.7)22 (34.4)0.227ACPA, anti-citrullinated peptides antibodies; csDMARDs, conventional synthetic disease-modifying anti-rheumatic drugs; IQR, interquartile range; NSAIDs, non-steroidal anti-inflammatory drugs; RF, rheumatoid factor; TNFi, tumor necrosis factor inhibitors. All data reported as absolute numbers (percentage) otherwise specified. P-value refers to Chi-squared or Fisher test for categorical variables or ANOVA for continuous variables.None declared