For patients with RA, the addition of a tumor necrosis factor inhibitor (TNFi) or of sulfasalazine and hydroxychloroquine (triple therapy) to methotrexate results in clinically important improvements in vascular inflammation, according to a study published in the Annals of Rheumatic Diseases. Daniel H. Solomon, MD, MPH, and colleagues randomly assigned 115 patients with active RA despite the use of methotrexate to the addition of a TNFi or of sulfasalazine and hydroxychloroquine for 24 weeks. Changes in arterial inflammation were examined as an index of cardiovascular risk, measured as an arterial target-to-background ratio (TBR) in the carotid arteries and aorta. Significant TBR reductions in both groups (ΔTNFi, −0.24; Δtriple therapy, −0.19) were observed with no significant difference between the groups. Both groups had significant reductions in disease activity, but no association was seen with change in TBR. “Prior trials in the general population have shown differential effects on the cardiovascular risk between different immunomodulators, but in our trial, two different immunomodulatory treatment strategies produced similar reductions in cardiovascular risk.” Dr. Solomon said in a statement.
