bDMARDs and tsDMARD (JAKI: baricitinib) reduce the risk of major adverse cardiovascular events (MACEs) in rheumatoid arthritis patients

Abstract

Background
Rheumatoid arthritis (RA) is an autoimmune disease associated with articular and extra-articular manifestations. RA has an increased cardiovascular diseases (CVD) risk, potentially due to systemic inflammation. Biological therapies may reduce cardiovascular risk by decreasing the inflammatory burden. The purpose of this study was to highlight the role of biological therapies on CVD risk in RA patients.


Methodology
An observational cross sectional study including 150 RA patients, cardiologically free. They were classified into three groups: Group (1): 50 RA patients received Conventional Synthetic Disease-Modifying Anti rheumatic Drugs (csDMARDs).Group (2): 50 RA patients received biological Disease-Modifying Anti rheumatic Drugs (bDMARDs) Group (3): 50 RA patients received targeted synthetic DMARD (tsDMARD) (Janus Kinase Inhibitor (JAKi): Baricitinib): All participants underwent full examination, laboratory tests, electrocardiography, echocardiography and cardiovascular risk evaluation using Framingham Risk score (FRS).


Results
Group Ⅰ (csDMARDs): 50 patients. Most were females (94%) and 3 male patients (6%), their ages ranged from 29 to 70 years. Group Ⅱ (bDMARDs): 50 patients. Most were females (90%) and 5 male patients (10%), their ages ranged from 25 to 70 years. Group Ⅲ (tsDMARD) (Baricitinib): 50 patients. Most were females (82%) and 9 male patients (18%), their ages ranged from 31 to 71 years. Patients on csDMARD showed higher statistically significant difference in prevalence of major adverse cardiovascular events (MACEs), Electrocardiography changes (St depression) and Echocardiography findings (Valvular lesions, Regional wall motion abnormalities and Left ventricular diastolic dysfunction ) compared to those on bDMARDs and tsDMARD, but there was no statistically significant difference between patients on biological or targeted therapies. Also, csDMARDs patients showed higher prevalence of intermediate CVD risk (calculated by FRS), compared to those on bDMARDs and tsDMARD, but there was no difference between bDMARDs patients and tsDMARD patients.


Conclusions
RA patients receiving bDMARDs or tsDMARDs (Baricitinib) showed lower observed MACEs incidence and lower DAS28 scores than those on csDMARDs.