Reassessing CVD Risk in Rheumatic Disease

September 23, 2020

Some drugs used to treat lupus and other connective tissue diseases have been shown to increase cardiovascular risks. Even so, those drugs remain effective in addressing disease symptoms, and a leading rheumatology researcher has suggested that concerns may not be fully warranted.

Some drugs used to treat lupus and other connective tissue diseases have been shown to increase cardiovascular risks. Even so, those drugs remain effective in addressing disease symptoms, and a leading rheumatology researcher has suggested that concerns may not be fully warranted.

“There are a lot of drugs we use that affect our patients’ CVD risk,” said Jeffrey Curtis, M.D., MPH, a rheumatologist and epidemiologist with University of Alabama Center for Education and Research on Therapeutics. Dr. Curtis recently spoke on this issue at the Congress of Clinical Rheumatology East 2020 annual meeting held earlier this month. “How to communicate risk...I think may be the next wave."

A 2017 comparative effectiveness study published in The New England Journal of Medicine found that romosozumab substantially outperformed alendronate in reducing clinical fractures in women with osteoporosis. The study found that adjudicated serious cardiovascular events for alendronate (N=2014) were 38 (1.9), while the group taking romozozumab (N=2040) experienced 50 (2.5) events—a finding that ultimately prompted a warning label from drug makers.

The warning raised flags, but Dr. Curtis said the risks are not necessarily high enough to outweigh romosozumab’s benefits.

“Even when compared to alendronate, there is still a significant benefit for vertebral fractures. It reduced vertebral fractures by half compared to alendronate,” Dr. Curtis said. “The warning caused some concern. But it’s less than one out of 100 people who had a [cardiovascular] event. Only more time and safety studies will tell, but it informs [how to] consider the risks and benefits.”

Dr. Curtis also pointed to a 2018 study published in The New England Journal of Medicine. Participants taking febuxostat (N=3098) had 134 (4.3) cardiovascular deaths, while the allopurinol cohort had 100 (3.2). Nevertheless, Dr. Curtis said the finding should not necessarily disqualify febuxostat as an option.

“I would not avoid using febuxostat,” Dr. Curtis said. “But I think some caution is warranted.”

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REFERENCE

Session: CCR East 2020 Saturday Morning, 10 a.m. – 1 p.m. Sub-session: “Cardiovascular Disease in Connective Tissue Disease: Do the Medications Help or Hurt?”