Heart Risk: Arthritis Drugs Compared

Nov. 29, 2006 - A new class of rheumatoid arthritis drugs is no different at cutting heart attack and stroke risk than an older treatment, a Harvard study shows.

In the study, patients taking biologics, which are designed to suppress a specific part of the immune system, were compared with patients taking only methotrexate, an older drug commonly used for rheumatoid arthritis.

Those taking biologics, such as Enbrel, Humira, Remicade, or Kineret, fared no better or worse than those on methotrexate alone, in terms of risk for heart attack or stroke, the study shows.

These drugs are called biologics because they are derived from living organisms.

However, the study did show that people taking oral steroids “appeared to have slightly greater cardiovascular risk” than patients who only took methotrexate.

Comparing Heart Risk

In rheumatoid arthritis, the immune system attacks the body instead of defending it. Doctors often prescribe drugs to suppress the immune system in order to control the disease.

Rheumatoid arthritis is also associated with a rise in heart risks.

This added risk is thought to be tied to the inflammation that is a key component of rheumatoid arthritis - and is increasingly thought to play a part in the development of heart diseaseas well.

This study, from Daniel Solomon, MD, MPH, and colleagues, looked at data from about 3,500 rheumatoid arthritis patients enrolled in Medicare.

The patients were 82 years old, on average. Most were elderly white women in frail health.

The patients had filled prescriptions for various drugs designed to suppress the immune system.

Over two years, 946 patients were hospitalized for a heart attack or stroke. Those taking biologic drugs weren't any more or less likely to have a heart attack or stroke than those only taking methotrexate.

While those taking oral steroids did appear to be more at risk than those on methotrexate, the researchers caution that this could be because methotrexate and biologic drugs may both protect the heart.

If that is the case, oral steroids may falsely look risky in comparison. The study doesn't settle that question.

The study has some limits.

The data didn't include information on some things that may affect cardiovascular risk, such as smoking, aspirin use, and BMI (body mass index) -- a gauge for appropriate weight.

With a mainly frail, elderly population, it was also hard to rule out other illnesses.

The study was published in Arthritis & Rheumatism.

It was funded in part by the drug companies Merck, Pfizer, and Savient. Merck and Pfizer are WebMD sponsors.

One of the researchers -- Michael Weinblatt, MD -- reports receiving consulting fees from various drug companies.