FRI0050 EFFICACY OF ATORVASTATIN VERSUS COLCHICINE IN DECREASING BIOMARKERS OF MYOCARDIAL DAMAGE IN PATIENTS WITH SEVERE RHEUMATOID ARTHRITIS
Authors: J. A. Alvarado, J. M. Lopez, A. C. Bardan, C. Abud-Mendoza
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with rheumatoid arthritis (RA) have been associated to higher morbidity and mortality due to cardiovascular events. The impact of atorvastatin and colchicine in reducing these complications has been evaluated without comparative studies of these drugs in RA patients. We assess whether atorvastatin is superior to colchicine in cardiovascular risk markers (high-sensitivity troponin I (hs-cTnI), echocardiographic abnormalities and inflammatory cytokine) in patients with RA Objectives: The primary objective was to compare the initial and final levels of hs-cTnI with both treatments. Secondary objectives: Describe initial echocardiographic abnormalities, compare changes in these alterations with treatment, evaluate factors associated with a higher level of hs-cTnI and echocardiographic abnormalities, compare changes in serum levels of inflammatory cytokines (TNF, IL 8, IL 1β, IL 6, IL 10, IL 12p70) and values of lipid profile Methods: Prospective randomized pilot study, blinded for cardiologist and rheumatologist, with patients with RA and severe disease activity (DAS 28&gt; 5.1), without known heart disease, kidney disease or previous use of atorvastatin and / or colchicine. Patients were assigned according to randomization in two groups: atorvastatin 40 mg/day or colchicine with an initial dose of 0.75 mg/day titled according to tolerance up to a maximum dose of 1.5 mg/day, both were received for four weeks. NCT04056039 Results: Recruitment of September 2018 to August 2019, 60 participants had undergone randomization (30 in each group) with a median age 48. The duration of follow-up from randomization was 28 days in each group. Participants were followed by weekly telephone contact to assess of adherence treatment. A detected value of hs-cTnI was found in all patients, initial value in the atorvastatin group: Median 1ng /L, IQR 1-2 and final: Median 1ng /L, IQR 1-3 vs initial value in the colchicine group: 1ng /L, IQR 1-2 and final: 1ng /L, IQR1-2 p = 0.67. Echocardiographic abnormalities in 46 patients (76.66%); 63.33% diastolic dysfunction, 15% tricuspid regurgitation and 11.66% left ventricular hypertrophy. There were changes in initial and final diastolic dysfunction in the atorvastatin group from 19 to 9 vs colchicine 19 to 12 p = 0.05, 95% CI 0.49-0.82. Correlation of initial hs-cTnI with age p &lt;0.001 and rheumatoid factor p = 0.02; correlation of diastolic dysfunction and age p &lt;0.001. There was a greater decrease in the level of tumor necrosis factor (TNF) and IL 1β in the atorvastatin group, however, decrease was higher in IL6 and IL12p70 in the colchicine group. Mild diarrhea was reported as the most frequent adverse effect in the atorvastatin group of 3.33% and colchicine of 23.33% p = 0.010. There was a statistically significant decrease in cholesterol and LDL-cholesterol levels in favor of treatment with atorvastatin Conclusion: We do not observe substantial differences in decrease in hs-cTnI with atorvastatin and colchicine, a prospective study of 222 patients is required to avoid β-type error. Echocardiographic abnormalities in 76% of patients showed a greater decrease in diastolic dysfunction in the atorvastatin group, as well as lower cholesterol and LDL-cholesterol levels, thus, as a tendency to falling of TNF and IL 1β in this group References: [1]Liao KP, Solomon DH. Traditional cardiovascular risk factors, inflammation and cardiovascular risk in rheumatoid arthritis Rheumatol 2013;52(1):45–52 [2]Papageorgiou N, Briasoulis A, Lazaros G. Colchicine for prevention and treatment of cardiac diseases: A meta-analysis Cardiovasc Ther 2017;35(1):10–8 [3]Li G min, Zhao J, Li B, et al. The anti-inflammatory effects of statins on patients with rheumatoid arthritis: A systemic review and meta-analysis of 15 randomized controlled trials Autoimmun Rev 2018;17(3):215–25 Disclosure of Interests: Jose Alfredo Alvarado: None declared, Juan Manuel Lopez: None declared, Ana Cecilia Bardan: None declared, Carlos Abud-Mendoza Speakers bureau: Eli Lilly, Pfizer Inc