AUTHOR=Hloch Karel , Doseděl Martin , Duintjer Tebbens Jurjen , Žaloudková Lenka , Medková Helena , Vlček Jiří , Soukup Tomáš , Pávek Petr 

TITLE=Higher Risk of Cardiovascular Diseases in Rheumatoid Arthritis Patients Without Methotrexate Treatment

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.703279

DOI=10.3389/fphar.2021.703279

ISSN=1663-9812

ABSTRACT=Cardiovascular diseases (CVD) lead to higher morbidity and mortality in rheumatoid arthritis, thus we aimed to determine whether patients who had discontinued methotrexate treatment before the study enrolment (group MTX 0) were at a higher risk of CVD than patients treated with methotrexate at the time of the data collection (group MTX 1). Retrospective-prospective observational cross-sectional study was conducted. A total of 125 patients were enrolled in the study. Patients from MTX 0 group (n=35) were not treated with methotrexate for 7.54 (SD ± 4.21) years in average. Medical documentation as well as information taken in patient examinations during regular rheumatologist visits was used to obtain the required data. The composite of any CVD occurred less frequently in patients in the MTX 1 group than in MTX 0 group (18.8% vs. 40.0%, OR 0.35, 95% CI 0.15 to 0.83; P=0.017) with non-significant trend after adjustment for other treatment, which differed between study groups at baseline (P=0.054). Significant difference was found for the reduction of myocardial infarction in the MTX 1 compared to the MTX 0 group (3.5% vs. 14.3%, OR 0.22, 95% CI 0.05 to 0,97; P=0.046. There were 4 deaths (4.7%) in the MTX 1 group as compared with 7 (20.0%) in the MTX 0 group (OR 0.20, 95% CI 0,05 to 0,73; P=0.015). Our results demonstrate that patients, who discontinued methotrexate treatment are at a significantly higher risk of CVD and all-cause mortality. Based on our findings, we recommend stricter control of CVD in cases of methotrexate discontinuation.