Risk of major adverse cardiovascular events following targeted therapy in patients with rheumatoid arthritis: a real-world analysis stratified by cardiovascular risk

Abstract

Objective To assess the risk of major adverse cardiovascular events (MACEs) associated with Janus kinase inhibitors (JAKi) compared to tumour necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA). Methods Using the Korean nationwide claims database, we identified patients with RA prescribed JAKi or TNFi between 2015 and 2019. Patients were stratified into two groups based on cardiovascular (CV) risk and matched within each group using propensity score matching at a ratio of up to 1:4. Follow-up continued until MACE, death, or treatment discontinuation. Hazard ratios with 95 % confidence intervals were calculated using the Cox proportional hazards model. Additionally, MACE risk was analyzed separately in patients with and without a history of cardiovascular disease (Hx.CVD). Results A total of 7575 patients prescribed either JAKi or TNFi were included. After propensity score matching, the hazard ratio for MACEs comparing JAKi to TNFi was 0.77 (95 % confidence interval 0.45–1.34) in the high CV risk group. No significant differences in MACEs were observed between JAKi and TNFi users across the low CV risk group, as well as Hx.CVD and non-Hx.CVD groups. Subgroup and sensitivity analyses showed no statistically significant differences in the risk of individual MACE components, such as myocardial infarction, stroke, or heart failure. Conclusion No significant differences in the risk of MACEs were observed between JAKi and TNFi users across various CV risk groups and in those with or without Hx.CVD. Subgroup and sensitivity analyses supported these findings, showing no elevated risks for individual MACE components.