Therapy with JAK inhibitors or bDMARDs and the risk of cardiovascular events in the Dutch rheumatoid arthritis population

Calin D Popa; Merel A A Opdam; Nathan den Broeder; Hanne van Ballegooijen; Kelly Mulder; Kayleigh M van de Wiel; Noortje van Herwaarden; Maike H M Wientjes; Alfons A den Broeder

doi:10.1093/rheumatology/kead531

Therapy with JAK inhibitors or bDMARDs and the risk of cardiovascular events in the Dutch rheumatoid arthritis population

Rheumatology (Oxford). 2023 Oct 5:kead531. doi: 10.1093/rheumatology/kead531. Online ahead of print.

Authors

Calin D Popa^{1

2}, Merel A A Opdam¹, Nathan den Broeder¹, Hanne van Ballegooijen³, Kelly Mulder³, Kayleigh M van de Wiel³, Noortje van Herwaarden¹, Maike H M Wientjes¹, Alfons A den Broeder¹

Affiliations

¹ Department of Rheumatology, Sint Maartenskliniek Nijmegen, The Netherlands.
² Department of Rheumatology, Radboudumc Nijmegen, The Netherlands.
³ IQVIA, Amsterdam, The Netherlands.

PMID: 37796830
DOI: 10.1093/rheumatology/kead531

Abstract

Objective: Caution has been advocated recently when using Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA) patients with an unfavorable cardiovascular risk profile. We aimed to compare the incidences in cardiovascular events between JAKi or bDMARDs in a large population of RA patients.

Methods: RA patients starting a new bDMARD or JAKi between August 1st 2018 and January 31st 2022 have been selected from IQVIA's Dutch Real-World Data Longitudinal Prescription database, covering about 63% of outpatient prescriptions in the Netherlands. Study outcome was a cardiovascular event, defined as the start of platelet aggregation inhibitors during study period. The incidence densities of cardiovascular events were compared between JAKi and bDMARDs using multilevel Poisson regression, adjusted for exposition time and confounders.

Results: 15 191 unique patients were included, with 28 481 patient-years on treatment with either JAKi (2,373) or bDMARDs (26 108). Most patients were female (72%) and median age was 62 years. We found 36 cardiovascular events (1.52 events/100 patient years) during therapy with JAKi and 383 events (1.47 events/100 patient years) during therapy with bDMARDs, respectively, resulting in an adjusted incidence rate ratio (IRR) of 0.99 for JAKi compared with bDMARDs (95% confidence interval (CI), 0.70-1.41). Sub-analyses in patients >65 years, by sex, or separately for tofacitinib and baricitinib, yielded similar results.

Conclusion: In a large Dutch general RA population, the risk of cardiovascular events seems not different between JAKi users and those using bDMARDs, although a small increase in higher risk patients cannot be excluded.

Keywords: JAK inhibitors; bDMARDs; cardiovascular risk; rheumatoid arthritis.