From the Guidelines
Methotrexate is associated with a lower risk of cardiovascular events, while Adalimumab's effect on cardiovascular risk is not clearly established.
Key Points
- Methotrexate has been shown to reduce the risk of cardiovascular events in patients with rheumatoid arthritis in observational studies 1.
- The use of biologic disease-modifying antirheumatoid drugs, such as Adalimumab, has been found to stabilize and decrease plaque in patients with rheumatoid arthritis, but its direct effect on cardiovascular risk is not well established 1.
- Methotrexate has been associated with both favorable and unfavorable lipid changes, but its overall effect on cardiovascular risk appears to be beneficial 1.
- A large double-blind trial found that low-dose methotrexate did not reduce the composite of cardiovascular death, non-fatal MI, non-fatal stroke, or unstable angina-driven revascularization in patients with previous MI or multivessel coronary atherosclerosis 1.
- Methotrexate has an acceptable safety profile and is appropriate for long-term use, with a lower mortality incidence rate and reduced cardiovascular mortality compared to patients without methotrexate 1.
Cardiovascular Risk
- Patients with rheumatoid arthritis are at increased risk of cardiovascular events, with a higher mortality rate after myocardial infarction 1.
- Methotrexate may help reduce this risk by modifying traditional risk factors and reducing systemic inflammation 1.
- Adalimumab, as a biologic disease-modifying antirheumatoid drug, may also play a role in reducing cardiovascular risk, but more research is needed to establish its direct effect.
- The European Heart Journal recommends considering the use of anti-inflammatory agents, such as methotrexate, in patients with chronic coronary syndromes 1.
From the Research
Cardiovascular Risk Associated with Methotrexate
- Methotrexate has been associated with a lower risk of cardiovascular disease (CVD) in patients with chronic inflammation 2, 3, 4, 5.
- A systematic review and meta-analysis found that methotrexate was associated with a 21% lower risk for total CVD and an 18% lower risk for myocardial infarction 2.
- Methotrexate improves cardiovascular risk in rheumatoid arthritis, psoriasis, and psoriatic arthritis by reducing systemic inflammation 4.
- The mechanisms of action of methotrexate on cardiovascular tissue are based on the antagonism of purines, reducing systemic inflammation and oxidative stress, and improving major cardiovascular risk factors 4.
Cardiovascular Risk Associated with Adalimumab
- There is no direct evidence provided in the studies to assess the cardiovascular risk associated with Adalimumab.
Combination Therapy with Methotrexate and Biologic Disease-Modifying Antirheumatic Drugs
- Concomitant use of methotrexate with biologic disease-modifying antirheumatic drugs (bDMARDs) has been associated with a 24% lower risk for CVD events among patients with rheumatoid arthritis 6.
- The benefits of methotrexate use on CVD risk among RA patients initiating bDMARDs were consistent across different outcomes, including myocardial infarction, stroke, and fatal CVD 6.