Improving Cardiovascular Outcomes for Rheumatoid Arthritis Patients
ATHEROSCLEROSIS rates were reduced in patients with rheumatoid arthritis as a result of adopting a treat-to-target approach compared with a traditional treatment approach, according to the results of an open-label, randomised, controlled trial.
A total of 320 patients <70 years old with rheumatoid arthritis were enrolled into the trial. The mean age of the patients was 52.4 years and none of the patients had a prior history of diabetes mellitus or cardiovascular disease. The patients were split into two groups: one receiving the typical care for traditional cardiovascular disease factors and the other receiving a treat-to-target approach.
The primary outcome of the study was carotid intima media thickness (cIMT) at baseline compared with 5 years; there were a number of secondary outcomes, including coronary artery bypass grafting, percutaneous coronary intervention, nonfatal stroke, and death due to cardiovascular causes. In an attempt to ameliorate the high rate of patient dropout (31.6% by 5 years), the researchers made use of all other available cIMT values, such as baseline and the measurements from years 1–4. The researchers explained: “Assuming that unobserved cIMT values were missing at random, missing data were imputed with multiple imputation using the fully conditional specification method for seven cycles.”
At 5-year follow-up patients in the treat-to-target group had a lower mean cIMT progression than the standard care group (0.023 mm; 95% confidence interval: 0.011–0.036 versus 0.045 mm; 95% confidence interval: 0.030–0.059; p=0.028). Additionally, the treat-to-target group had a statistically significant reduction in cardiovascular events (1.3% versus 4.7%; p=0.048). The researchers commented: “In light of the reduction of cardiovascular events, these effects [the reduction in cIMT progression] are, in our opinion, clinically relevant.”
However, it should be noted that there were a number of limitations to this study that necessitate further investigation. In addition to the high dropout rate, the study was underpowered and the cIMT progression measurement was unblinded are all factors that limited the trial.