Giles JT, Sattar N, Gabriel S, et al. - In this randomized, open-label, parallel-group trial, researchers compared the risk for major adverse cardiovascular events (MACE) in RA patients treated with tocilizumab vs the tumor necrosis factor inhibitor etanercept. The study sample consisted of 3,080 patients with active seropositive RA, inadequate responses to conventional synthetic disease-modifying antirheumatic drugs, and at least one cardiovascular risk factor. Participants in the study were randomly assigned 1:1 to open-label tocilizumab 8 mg/kg/month or etanercept 50 mg/week and followed up for an average of 3.2 years. By week 4, serum low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were 11.1%, 5.7%, and 13.6%, respectively, higher for tocilizumab-assigned patients vs etanercept. Eighty-three MACE occurred in the tocilizumab group vs 78 in the etanercept group during follow-up. The trial, which offers insights into tocilizumab vs etanercept's cardiovascular safety, ruled out a relative risk of 1.43 or greater for MACE. This outcome should be viewed in the context of tocilizumab's clinical effectiveness and non-cardiovascular safety. Serious infection and gastrointestinal perforation included adverse events that occurred more frequently in the tocilizumab group.