POS0218 TUMOR-NECROSIS FACTOR INHIBITORS IMPROVE AORTIC STIFFNESS IN PATIENTS WITH LONGSTANDING RHEUMATOID ARTHRITIS
Authors: A. Giollo, G. Cioffi, G. Orsolini, F. Ognibeni, A. Dalbeni, R. Bixio, G. Adami, A. Fassio, L. Idolazzi, D. Gatti, M. Rossini, O. Viapiana
Journal: Annals of the Rheumatic Diseases (2021)

Background: 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. Objectives: 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). Methods: 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. Results: 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&lt;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&lt;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 &gt;2 CVD risk factors than in those without (figure 1). Conclusion: 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 value Age, median years (IQR) 58.6 (53.0, 66.0) 58.1 (49.3, 67.0) 0.839 Female sex 33 (76.7) 54 (84.4) 0.321 Obesity 5 (11.6) 7 (10.9) 0.999 Hypertension 19 (44.2) 30 (46.9) 0.784 Anti-hypertensive drug 17 (39.5) 28 (43.8) 0.784 Smoking status, ever 18 (42.9) 30 (46.9) 0.684 Dyslipidemia 30 (40.2) 34 (59.8) 0.085 Current statin use 13 (34.2) 10 (15.9) 0.033 Diabetes mellitus 3 (7.0) 3 (4.7) 0.676 Anti-diabetic medication 1 (2.3) 1 (1.5) 0.999 CVD risk factors, median (IQR) 2 (1, 3) 2 (1, 3) 0.199 RF and/or ACPA positive 28 (65.1) 33 (51.6) 0.165 Disease duration, median years (IQR) 14.1 (11.5) 15.4 (10.5) 0.538 Methotrexate 38 (88.4) 52 (81.3) 0.192 Leflunomide 5 (17.9) 12 (19.0) 0.999 Hydroxychloroquine 9 (31.0) 5 (7.8) 0.009 Prednisone &gt; 5 mg daily 7 (7.7) 5 (5.5) 0.823 NSAIDs 6 (20.7) 22 (34.4) 0.227 ACPA, 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. Disclosure of Interests: None declared