TY - JOUR T1 - Benefits of Methotrexate Use on Cardiovascular Disease Risk Among Rheumatoid Arthritis Patients Initiating Biologic Disease-modifying Antirheumatic Drugs JF - The Journal of Rheumatology JO - J Rheumatol SP - 804 LP - 812 DO - 10.3899/jrheum.191326 VL - 48 IS - 6 AU - Fenglong Xie AU - Lang Chen AU - Huifeng Yun AU - Emily B. Levitan AU - Jeffrey R. Curtis Y1 - 2021/06/01 UR - http://www.jrheum.org/content/48/6/804.abstract N2 - Objective. Methotrexate (MTX) has been associated with reduced risk for cardiovascular disease (CVD) events among patients with rheumatoid arthritis (RA) not exposed to biologic disease-modifying antirheumatic drugs (bDMARDs). The effect of concomitant MTX on CVD risk among RA patients initiating bDMARDs remains unknown.Methods. A retrospective cohort study was conducted to assess the effect of MTX on CVD risk using 2006–2015 Medicare claims data for patients with RA initiating bDMARD. The main exposure was current use of MTX, updated in a time-varying fashion. The primary outcome was a composite of incident myocardial infarction (MI), stroke, and fatal CVD. Secondary outcomes were each event that comprised the primary outcome. Incidence rates (IR) and 95% CI were calculated using Poisson regression. Associations between MTX and risk of CVD were assessed using Cox regression.Results. A total of 88,255 bDMARD initiations and 1861 CVD events were included in this study. Mean age was 64.6 (12.3) years, 84.0% were female, and 68.2% were non-Hispanic White. The crude IRs (95% CI) for CVD were 17.9 (16.9–18.8) and 12.1 (11.1–13.2) per 1000 patient-years among MTX unexposed and exposed, respectively. The multivariable adjusted HR (95% CI) for CVD events associated with MTX was 0.76 (0.68–0.85). Multivariable adjusted HRs were 0.78 (0.66–0.91), 0.74 (0.62–0.88), 0.77 (0.68–0.86), and 0.82 (0.73–0.93) for MI, stroke, MI or stroke, and a composite CVD outcome, respectively. Results were robust in sensitivity and subgroup analyses.Conclusion. Among patients with RA receiving biologics, concomitant MTX use was associated with a 24% lower risk for CVD events. ER -