A 62-year-old woman with seropositive erosive RA has failed two conventional DMARDs. Anti-CCP antibodies are strongly positive. She has no tuberculosis risk factors, eGFR 65, and no hepatitis B. Which biologic or targeted synthetic DMARD has cardiovascular safety data that should be considered in a patient with a history of MI 3 years ago?

• A Tofacitinib is the preferred agent given its rapid onset
• B Abatacept or TNF inhibitor rather than tofacitinib ✓
• C Baricitinib at high dose (4 mg) is the safest JAK inhibitor
• D Upadacitinib is preferred over biologics in all post-MI patients

Explanation

The ORAL Surveillance trial demonstrated increased MACE (major adverse cardiovascular events) and malignancy risk with tofacitinib vs. TNF inhibitors in patients aged >50 with cardiovascular risk factors. Post-MI status is a high cardiovascular risk condition; regulatory agencies (FDA, EMA) now recommend caution with JAK inhibitors in patients with high CV risk, and biologics (TNF inhibitors, abatacept) are preferred. All JAK inhibitors carry this class warning. Abatacept has a particularly favourable CV safety signal.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.