POS0059 CARDIOVASCULAR RISK AND ADVANCED THERAPIES RETENTION IN RHEUMATOID ARTHRITIS: RESULTS FROM THE OBRI
Authors: Aboulenain S. , LI X. , Movahedi M. , Bombardier C. , Kuriya B. 
Published: June 2023

Background

Cardiovascular disease (CVD) and CVD risk factors are highly prevalent in rheumatoid arthritis (RA) and associated with morbidity and mortality. We previously reported an association between CVD risk factors and higher disease activity and disability.[1]However, whether CVD risk factors influence advanced therapy drug retention is not well known.

Objectives

We aimed to test the hypothesis that CVD risk factors are associated with lower retention of biologic and targeted synthetic disease modifying antirheumatic drugs (bDMARD, tsDMARD) among methotrexate inadequate responders (MTX-IR).

Methods

Participants enrolled in the Ontario Best Practices Initiative (OBRI) RA registry were included if they initiated their first bDMARD or tsDMARD, had at least one follow-up visit after initiation and available baseline data on CVD risk factors. Patients were grouped by number of baseline CVD risk factors (0, 1 or >1), including hypertension, dyslipidemia, diabetes, obesity (body mass index ≥30) and current smoking. The primary outcome was time-to-discontinuation of a first bDMARD or tsDMARD. Multivariable Cox proportional hazards model, adjusted for clinically important confounders, estimated the association between CVD risk factors and drug retention. Sensitivity analyses for exploring types of discontinuation (primary failure, secondary failure and adverse events) were performed.

Results

A total of 877 patients were included. The majority were new initiators of bDMARDs (89%). The mean (SD) age was 57 (12) years and 79% were females. At least 1 CVD risk factor was present in 75%, most commonly hypertension (33%). The most common reasons for treatment discontinuation were primary failure (N=72), secondary failure (n=126) or adverse events (N=133), compromising 64% of all cause discontinuation. Patients without CVD risk factors had longer drug survival with a mean of 31 months, compared to 28 and 27 months in patients with 1 or > 1 CVD risk factors, respectively. In multivariate analysis, the presence of at least 1 CVD risk factor was not associated with a higher risk of medication discontinuation overall (HR 1.12, 95%CI 0.89-1.40, p=0.32), nor was the presence of ≥ 2 CVD risk factors (HR 1.20, 95% CI 0.93-1.54, p=0.16) (Figure 1). However, CVD risk factors were associated with discontinuation due to the composite of treatment failure and adverse events; and ≥ 2 CVD risk factors was strongly associated with secondary treatment failure (Table 1).

Conclusion

More than half of biologic naïve RA patients who had inadequate response to methotrexate will discontinue their initial bDMARD or tsDMARD. The presence of more than 1 CVD risk factor, compared to no risk factors, is associated with reduced bDMARD/tsDMARD retention. This appears to be driven by secondary treatment failure. Further investigation into the possible mechanisms by which CVD comorbidity contributes to treatment failure is required.

Reference

[1]Cui K, Movahedi M, Bombardier C, Kuriya B. Cardiovascular risk factors are negatively associated with rheumatoid arthritis disease outcomes.Ther Adv Musculoskelet Dis. 2021;13:1759720X20981217. Published 2021 Feb 15. doi:10.1177/1759720X20981217

Acknowledgements

Acknowledgment: OBRI investigators. Ontario Best Practices Research Initiative (OBRI) was funded by peer-reviewed grants from the Canadian Institute for Health Research, Ontario Ministry of Health and Long-Term Care, Canadian Arthritis Network, and unrestricted grants from AbbVie, Amgen, Aurora, BMS, Celgene, Gilead, Hospira, Janssen, Lilly, Medexus, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, and UCB.

Disclosure of Interests

None Declared.