Comparative Effects of csDMARDs on Stroke and Myocardial Infarction Risk in Rheumatoid Arthritis

Researchers quantified the comparative effect of csDMARDs on the risk for myocardial infarction and stroke in rheumatoid arthritis.

The risk for stroke associated with the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDS) varies between different monotherapies, according to study results presented at the European League Against Rheumatism (EULAR) 2020 E-Congress, held online from June 3 to 6, 2020.

Using data from 6 electronic health records databases across Germany, the United States, and the United Kingdom, investigators aimed to assess the effects of various csDMARDS on the risk for cardiovascular and cerebrovascular events in patients with rheumatoid arthritis (RA).

A total of 145,248 patients with RA were followed up for 5 years or until the time of first event (myocardial infarction or stroke) or death. Patients received either methotrexate (n=73,996), hydroxychloroquine (n=49,752), sulfasalazine (n=12,256), or leflunomide (n=9244). The risk for myocardial infarction or stroke associated with use of each drug was compared with methotrexate use as a reference.

Myocardial infarction and stroke occurred at a rate of 7.64 and 10.26 per 1000 person-years, respectively, in patients treated with methotrexate. Compared with methotrexate users, patients with RA who received hydroxychloroquine (calibrated hazard ratio [cHR], 0.86; 95% CI, 0.78-0.95) or sulfasalazine (cHR, 0.71; 0.52-0.98) had a lower risk for stroke. There was no significant difference in the risk for stroke associated with leflunomide use. The risk for myocardial infarction was similar across all treatments.

Intention to treat and “on treatment” analyses had similar results.

“Overall, all [4] csDMARDs had similar effects on [myocardial infarction] risk. [Hydroxychloroquine] and [sulfasalazine] use were associated with a decreased risk [for] stroke compared to [methotrexate],” the researchers concluded. “The observed differences may be attributable to differential effects on the atherosclerotic process, differential disease control, or both.”

Disclosures: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Prats-Uribe A, Illingens B, Vizcaya D, et al. Cardio- and cerebrovascular risk with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in rheumatoid arthritis (RA): A real-world comparative assessment. Presented at: EULAR 2020 E-Congress; June 3-6, 2020. Abstract SAT0131.

This article originally appeared on Rheumatology Advisor