Does tocilizumab increase cardiovascular risk in patients with rheumatoid arthritis?

This study investigated if tocilizumab (TCZ; Actemra) increases cardiovascular (CVD) risk in patients with rheumatoid arthritis (RA).
They found that CVD risk associated with TCZ was similar to other biological drugs. 

Some background

Rheumatoid arthritis (RA) is caused by excessive inflammation. Inflammation leads to pain and swelling in the joints. Patients with RA also have a higher risk of cardiovascular (CVD) complications. Patients with RA that have a high disease activity have elevated CVD risk.  Tocilizumab (TCZ) is a drug to treat RA. It is a biological drug. It acts as an antibody and binds to the interleukin-6 (IL-6; an inflammation marker) receptor. TCZ prevents IL-6 from causing further inflammation. TCZ may also have effects on lipids (fats) found in the blood. This raises concern for the cardiovascular system (heart and blood vessels). High lipid profiles can lead to cardiovascular disease (CVD). Some studies suggest that TCZ increases CVD risk, but its effect on the CVS system remains under investigation. 

Methods & findings

This study included the records of 88,463 patients with RA taking biological drugs. Patient data was analyzed to determine if there was a risk to cardiovascular health. The CVD risk was calculated for each biological drug.  The CVD risk associated with TCZ is similar or lower than with other biological drugs. The risk of CVD was 27% greater in patients taking other biological drugs compared to TCZ. TCZ (along with etanercept) had the lowest risk of fatal CVD. This was not affected by other CVD risk factors. 

The bottom line

The authors concluded that CVD risk associated with TCZ was similar to other biological drugs for the treatment of RA.

If you have any concerns regarding RA and CVD risk, please consult with your physician.