Statins Mitigate Risk With Tofacitinib in RA Patients with ASCVD

A post hoc analysis of the ORAL surveillance study presented at the American College of Rheumatology (ACR) Convergence 2024, held November 14-19 in Washington, DC, sheds new light on cardiovascular (CV) risk management for rheumatoid arthritis (RA) patients. The study emphasizes the importance of statin use in reducing major adverse cardiovascular events (MACE) in patients with a history of atherosclerotic cardiovascular disease (ASCVD) treated with tofacitinib.

ORAL surveillance, a safety study comparing tofacitinib (5 mg and 10 mg twice daily) with tumor necrosis factor inhibitors (TNFi), had previously identified a higher incidence of MACE with tofacitinib. This analysis further examined statin use patterns, its impact on lipid levels, and the association between statin use and MACE in the study population of RA patients aged ≥50 years with at least 1 CV risk factor.

Key findings include:

                  •               Underutilization of Statins: Despite clinical guidelines recommending statin therapy for ASCVD patients and those at high CV risk, only 53.0% of patients with ASCVD and 26.9% of high-risk patients were on statins at baseline, with few using high-intensity statins.

                  •               Lipid Changes with Tofacitinib: LDL and HDL cholesterol levels increased in all patients, but more markedly in those treated with tofacitinib compared to TNFi.

                  •               MACE Risk Reduction with Statins: Among tofacitinib-treated patients with ASCVD, statin use was associated with a 51% reduction in MACE risk (HR 0.49, 95% CI 0.25–0.95). Without statins, tofacitinib users had a fourfold increased risk of MACE compared to TNFi users (HR 4.07, 95% CI 1.20–13.82).

“This post hoc analysis of ORAL Surveillance emphasizes that there is a gap in the CV preventive care of pts with RA, as evident from inadequate use of statins,” concluded the study authors. “Among pts with history of ASCVD, use of statins appears to be critical in mitigating the previously reported MACE risk observed to accompany tofacitinib use vs TNFi.”

Reference

Giles J, Charles-Schoeman c, Buch M, Dougados M, Szekanecz Z, et al. Use of statins and its association with major adverse cardiovascular outcomes with tofacitinib versus TNF inhibitors in a risk-enriched population of patients with rheumatoid arthritis [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9).