Tocilizumab and Cardiovascular Risk in RA Patients

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Tocilizumab, an interleukin-6 antagonist, is known to raise LDL cholesterol levels.
Tocilizumab, an interleukin-6 antagonist, is known to raise LDL cholesterol levels.

Findings from a population-based cohort study in Arthritis & Rheumatology show no evidence of a higher cardiovascular (CV) risk among rheumatoid arthritis (RA) patients who switch from a different biologic drug or tofacitinib to tocilizumab vs to a tumor necrosis factor inhibitor (TNFi).1

Tocilizumab, an interleukin-6 antagonist, is known to raise LDL cholesterol levels but it is unclear whether the drug raises CV risk n RA patients. Study authors from the Brigham and Women's Hospital, Boston, Massachussetts, and Genentech, San Francisco, California, aimed to compare cardiovascular safety by conducting a cohort study of RA patients who newly initiated tocilizumab or TNFi using multi-database claims data. Patients included in the study were required to have previously used a different TNFi, abatacept, or tofacitinib. The primary outcome was the composite cardiovascular endpoint of hospitalization for myocardial infarction (MI) or stroke. 

A total of 9218 patients started on tocilizumab were propensity score matched to 18,810 TNFi starters. Baseline cardiovascular disease was observed in 14.3% of tocilizumab patients and 13.5% of TNFi patients. During the study, 125 composite cardiovascular events occurred resulting in an incidence rate of 0.52 per 100 person-years among tocilizumab initiators vs 0.59 per 100 person-years among TNFi initiators. 

Study authors concluded that the risk of cardiovascular events associated with tocilizumab use vs TNFi was similar across all 3 databases analyzed (combined hazard ratio [HR] 0.84, 95% CI: 0.56–1.26). 

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Reference

  1. Kim SC, Solomon DH, Rogers JR, et al. Cardiovascular Safety of Tocilizumab versus Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis - a Multi-database Cohort Study. Arthritis Rheumatol. 2017. doi: 10.1002/art.40084
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