Risk of major adverse cardiovascular events in patients with rheumatoid arthritis treated with conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs: observational data from the German RABBIT register
Authors' conclusion
In this German observational cohort study, MACE did not occur more frequently with JAKi compared with other DMARDs. However, individual JAKis showed different unadjusted IRs.
Study context
- Population
- Patients with rheumatoid arthritis (RA) initiating DMARD treatment episodes January 2017–April 2022, German RABBIT register14,203 treatment episodes
- Exposure
- Janus kinase inhibitors (JAKi), other bDMARDs and csDMARDs vs tumour necrosis factor inhibitors (TNFi)
- Outcome
- MACE
Methodological detailsbiologics register, inverse probability of treatment weight-adjusted Andersen-Gill models
- Biologics register
- Inverse probability of treatment weight-adjusted Andersen-Gill models
Main finding
As reported in the abstract
MACE, overall
JAKi
0.68
IR per 100 patient-years · 95% CI 0.47–0.95
TNFi
0.62
IR per 100 patient-years · 95% CI 0.45–0.83
bDMARDs
0.76
IR per 100 patient-years · 95% CI 0.53–1.06
csDMARDs
0.95
IR per 100 patient-years · 95% CI 0.68–1.29
Each group vs TNFiAdjusted hazard ratio (95% CI)
JAKi
0.89(0.52–1.52)
csDMARDs
1.36(0.85–2.19)
- bDMARDs
- aHR 0.76 (95% CI 0.45; to1.27)
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| MACE in cardiovascular risk patients (age ≥50 years and ≥1 cardiovascular risk factor)JAKivs TNFi | 0.74 (0.41–1.31) | |
| MACE in cardiovascular risk patients (age ≥50 years and ≥1 cardiovascular risk factor)bDMARDsvs TNFi | 0.75 (0.45–1.27) | |
| MACE in cardiovascular risk patients (age ≥50 years and ≥1 cardiovascular risk factor)csDMARDsvs TNFi | 1.21 (0.74–1.98) | |
| 0.512Adjusted hazard ratio (log scale) |
IR
Baricitinib
0.49(95% CI 0.25–0.85)
Tofacitinib
0.98(95% CI 0.58–1.55)
Upadacitinib
0.53(95% CI 0.15–1.36)
- Unadjusted
MACE in cardiovascular risk patients (age ≥50 years and ≥1 cardiovascular risk factor)
- Incidence rates (IRs) were higher in cardiovascular risk patients
MACE in patients ≥65 years, with cardiovascular history or smokers, and with csDMARD as reference
- HRs not increased
Original publication
Risk of major adverse cardiovascular events in patients with rheumatoid arthritis treated with conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs: observational data from the German RABBIT register. RMD Open. Published 25 October 2023. doi:10.
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