Cardiovascular Safety of Biologics and JAK Inhibitors in Patients with Rheumatoid Arthritis

Current Rheumatology Reports
Eun Ha KangSeoyoung C Kim

Abstract

Increased cardiovascular (CV) risk and associated mortality in rheumatoid arthritis (RA) are not fully explained by traditional CV risk factors. This review discusses the epidemiology and mechanisms of increased CV risk in RA and treatment effects on CV risk focusing on biologic disease-modifying anti-rheumatic drugs (DMARDs) and JAK inhibitors. Intermediary metabolic changes by inflammatory cytokines are observed in body composition, lipid profile, and insulin sensitivity of RA patients, leading to accelerated atherosclerosis and increased CV risk. Successful treatment with DMARDs has shown beneficial effects on these metabolic changes and ultimately CV outcomes, in proportion to the treatment efficacy in general but also with drug-specific mechanisms. Recent data provide further information on comparative CV safety between biologic DMARDs or JAK inhibitors as well as their safety signals for non-atherosclerotic CV events. CV benefits or safety signals associated with DMARD treatments can differ despite similar drug efficacy against RA, suggesting that both anti-inflammatory and drug-specific mechanisms are involved in altering CV risk.

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Citations

May 31, 2019·Current Opinion in Lipidology·Rachel H MackeyLarry W Moreland
Dec 11, 2019·The Journal of Experimental Medicine·Hung-Jen ChenMenno P J de Winther
Jul 16, 2021·Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders·Mir Sohail FazeliLeticia Ferri
Sep 4, 2020·Current Drug Targets·Virginia SolitanoSilvio Danese

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