5PSQ-045 Analysis of cardiovascular risk associated with Janus kinase inhibitors treatment in patients with rheumatoid arthritis

<h3>Background and Importance</h3> Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular morbidity and mortality due to chronic inflammation. Though Janus kinase inhibitors (JAKi) are linked to higher cardiovascular event risk but the association remains unclear. <h3>Aim and Objectives</h3> Outcome analysis of the occurrence of cardiovascular adverse events and cardiovascular risk in RA patients on treatment with JAKi. <h3>Material and Methods</h3> Observational, retrospective, multicentre study of all patients with RA treated with JAKi for a minimum duration of 12 months. Clinical variables: sex, age, smoking, Charlson Comorbidity Index, cardiovascular risk score,¹ previous cardiovascular pathologies, JAKi treatment, duration, adverse effects or dose modifications. Major adverse cardiac events (MACE) were recorded and when they occurred as well as their outcome (emergency visit, hospitalisation, death). Data were obtained from electronic prescription and electronic medical records. R commander was used for the statistical analysis. <h3>Results</h3> 71 patients with JAKi treatment were included. 85.9% female, median age 58 (IQR 48.5–65.5). Median Charlson Comorbidity Index 1(IQR 1–2). 47.8% ex-smokers and 18.3% smokers.The median 10-year risk of cardiovascular events was 1.5% (IQR 1–3). At baseline: 32.4% arterial hypertension, 25.3% dyslipemia, 11.2% diabetes, 4.2% ischaemic heart disease, 4.2% cerebrovascular disease and 2.8% acute myocardial infarction. Treatments: 38 tofacitinib, 17 baricitinib, 12 upadacitinib and four filgotinib. The median treatment duration was 31 months(IQR 15.1–40.9). 12.6% reduced the dose, 7% increased their treatment dosage and 54.9% discontinued treatment (48.7% secondary failure, 23% adverse effects, 17.9% primary failure and 10.2% other reasons). 56.4% of patients who discontinued started treatment with another JAKi. Upadacitinib was the most prescribed (50%). 12 patients(16.9%) developed MACE during the treatment (six dyslipemia, three arterial hypertension, one diabetes, one ischaemic heart disease and one deep vein thrombosis). Two patients needed hospitalisation. MACE occurred after a median of 2 years (IQR 1–3). Statistically significant differences were found between MACE and smoking (p=0.01). No deaths from MACE. <h3>Conclusion and Relevance</h3> The development of MACE occurs in a modest number of patients with no associated mortality in this study. A statistically significant association was found with smoking. It is necessary monitoring and management of modifiable risk factors in this patient population. <h3>References and/or Acknowledgements</h3> Peter MJ, <i>et al</i>. EULAR evidence-based recommendations for cardiovascular disease management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. <i>Ann Rheum Dis</i> 2010;<b>69</b>:325–31. <h3>Conflict of Interest</h3> No conflict of interest