Rheumatoid Arthritis Activity Test May Predict Cardiovascular Risk

A test used to predict future disease activity in patients with rheumatoid arthritis (RA) might someday tell physicians which patients are at risk for cardiovascular events, such as heart attacks or coronary infection, a new study suggests.

On Monday, a researcher from the University of Alabama Birmingham, Jeffrey R. Curtis, MD, MPH, is presenting results of a population health study at the 2016 meeting of the American College of Rheumatology, taking place in Washington, DC. Using data from 17,000 patients culled from a large Medicare claims database, Curtis and his team examined the relationship between scores on a Vectra DA test, made by Crescendo Bioscience, and the risk of cardiovascular outcomes and infections.

Results showed that a high Vectra DA score was associated with an increased risk for coronary infections that required hospitalization, myocardial infarction, and composite coronary heart disease, including percutaneous coronary intervention and coronary artery bypass graft, according to a press release.

In an interview, officials with Crescendo Bioscience emphasized that there are no current plans to pursue using Vectra DA to find out which RA patients face cardiovascular risks. However, they said the findings are not surprising, since most of the 1.5 million patients in the United States with RA die of conditions other than the disease.

“Cardiovascular risk with rheumatoid arthritis is very real,” said Bernard Tobin, president of Crescendo Bioscience, a subsidiary of Myriad Genetics. “People don’t die of swollen joints, but they do die of cardiovascular disease quite often, because it’s inflammatory.”

Vectra DA is a blood test that examines 12 biomarkers associated with RA; the test generates a score that helps rheumatologists gauge the course of disease progression and guide treatment. The test’s purpose is to give physicians an objective measure that reduces the guesswork in clinical decision-making. Historically, rheumatologists made treatment decisions in part through subjective tests, such as how much pain patients say they feel in their joints during exams.

David Chernoff, MD, Crescendo’s senior vice president for Medical Affairs, said there’s a great deal of work that occurs with cardiovascular risk profiling among patients with diabetes and obesity—conditions that also involve inflammation—to assess whether drugs for these conditions put patients at higher risk for CV events. (FDA has required large studies, known as cardiovascular outcomes trials, for all new diabetes and obesity drugs since 2008.) But less has been done to identify which RA patients are at high risk, despite the known connections between the disease and CV events.

“Just having RA doubles the risk” of having a heart attack or stroke, Chernoff said.

Using Vectra DA to identify which patients face increased cardiovascular risks would require much more study and much larger data sets, and Crescendo has no plans to pursue the question right now. But it would fulfill an unmet need, Chernoff said. It’s possible that in the future, Vectra DA could identify a patient whose RA is not progressing rapidly, but, he said, “the test would indicate they need to be treated aggressively for cardiovascular outcomes.”

Reference

Curtis JR. Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based study. Presented at the 2016 Meeting of the American College of Rheumatology, Washington, DC. Abstract 1482.