TNF Inhibitors May Cut Heart Risk in Ankylosing Spondylitis

TOPLINE:

Patients with ankylosing spondylitis who were exposed to tumor necrosis factor (TNF) inhibitors had an approximately 30% lower risk for cardiovascular events than those who had never been exposed to any biologic disease-modifying antirheumatic drugs (bDMARDs).

METHODOLOGY:

• The researchers conducted a nationwide population-based cohort study to assess the effects of TNF and interleukin-17 (IL-17) inhibitors on the risk for cardiovascular events in patients with ankylosing spondylitis.
• They extracted the data of 43,502 patients (mean age, 41.2 years; 29.3% women) from the Korean nationwide database who were diagnosed with ankylosing spondylitis from 2010 onward and did not have a prior history of cardiovascular events.
• Overall, 12,698 and 464 patients contributed person-time to the TNF and IL-17 inhibitor cohorts, respectively.
• Cardiovascular events were defined as new cases of myocardial infarction or stroke.
• The risk for cardiovascular events was compared between individuals exposed to TNF inhibitors and those not exposed to any bDMARDs, as well as between those exposed to IL-17 inhibitors and those not exposed to either bDMARDs or TNF inhibitors.

TAKEAWAY:

• The incidence rates of cardiovascular events were 18.66, 8.92, and 12.87 per 10,000 person-years in the bDMARDs nonexposure, TNF inhibitor exposure, and IL-17 inhibitor exposure cohorts, respectively.
• Exposure to TNF inhibitors was associated with a lower risk for incident myocardial infarction or stroke (adjusted hazard ratio [aHR], 0.697; P = .034) and heart failure (aHR, 0.774; P = .010) compared with nonexposure to any bDMARDs.
• However, IL-17 inhibitor exposure showed no significant association with cardiovascular risk compared with bDMARDs nonexposure (P = .969) or TNF inhibitor exposure (P = .750).
• Subgroup analyses revealed that the protective effect of TNF inhibitor exposure on the risk for incident myocardial infarction or stroke was prominent in patients without dyslipidemia.

IN PRACTICE:

“Our findings provide relevant clinical information regarding the treatment of patients with AS [ankylosing spondylitis], particularly regarding the effect of therapeutic agents on cardiovascular risks,” the authors wrote.

SOURCE:

This study was led by Oh Chan Kwon, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea, and was published online on November 7, 2024, in Clinical Rheumatology.

LIMITATIONS:

This study lacked information on genetics, smoking, and alcohol consumption, which may have affected the results. The number of patients exposed to IL-17 inhibitors was relatively small and the total person-years of IL-17 inhibitor exposure was short, potentially affecting the risk estimation. The study population was Korean, limiting the generalizability of the findings.

DISCLOSURES:

This study did not mention any source of funding. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.