In a nutshell
The study evaluated the effectiveness of reducing cardiovascular events (CVE) with immunomodulatory (IM) in patients with rheumatoid arthritis (RA). The main finding was that IM showed improvements in vascular inflammation in this group of patients.
Some background
IMs are drugs that modify the immune system to help the body respond to a disease. Many IMs have been shown to reduce the risk of cardiovascular or heart disease for the general population. However, there are not many studies on RA patients. RA is an autoimmune disorder causing joint inflammation and pain. About 50% of people with RA are at risk of heart conditions. However, there is a possibility to reduce the risk of cardiovascular events (CVEs) by modifying treatments.
Previous studies showed that patients with RA had a 54% reduction of CVEs with TNF inhibitor (TNFi) and 21% with low-dose methotrexate (MTX; Trexall). MTX is a chemotherapy drug and an immune-system suppressant. TNFis such as adalimumab (Humira) are drugs that reduce the levels of tumor necrosis factor (TNF), an inflammatory protein.
However, modifying treatment strategies was not investigated. Therefore, it is important to compare the effectiveness of reducing vascular inflammation by adding TNFi to low-dose MTX versus a triple therapy of low-dose methotrexate with other immune suppressant drugs such as hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).
Methods & findings
This study included 115 patients with RA. The patients were randomly assigned to either the TNFi group or the triple therapy group for 24 weeks. The TNFi group was either given adalimumab (Humira) 40mg every other week or etanercept (Enbrel) 50mg every week along with low-dose MTX. The triple therapy included low-dose MTX with hydroxychloroquine and sulfasalazine. FDG-PET/CT scans were done to evaluate any change in vascular inflammation.
Both treatment groups showed a significant reduction in vascular inflammation in patients with RA. However, there was no statistical difference between the two groups. Both treatment groups had significant and similar reductions in RA activity and inflammatory markers.
The bottom line
The study concluded that immunomodulators such as TNFis and triple therapy can reduce vascular inflammation in patients with RA.
The fine print
The follow-up was short. The study drug was supplied by Abbvie, the manufacturer of adalimumab, and Amgen, the manufacturer of etanercept.
Published By :
Annals of the rheumatic diseases
Date :
Nov 30, 2022
