Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review.

Westlake SL, Colebatch AN, Baird J, Curzen N, Kiely P, Quinn M, Choy E, Ostor AJ, Edwards CJ.

Department of Rheumatology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. cedwards@soton.ac.uk.

Abstract

Objectives. RA is associated with early ischaemic heart disease. This appears to be driven largely by the presence of chronic inflammation. Studies suggest that treatment with disease-modifying drugs such as MTX may reduce the incidence of cardiovascular events in RA. Anti-TNF therapies significantly reduce inflammation in RA. However, the extent to which these agents also reduce cardiovascular disease (CVD) is uncertain. The purpose of this study was to explore the effect of anti-TNF agents on CVD in RA using a systematic literature review. Methods. We searched for studies of adults with RA treated with TNF antagonists where cardiovascular outcomes were recorded using MEDLINE, EMBASE, Cochrane Database, Database of Abstracts and Reviews of Effects, Health Technology Appraisal, Science Citation Index and Clinical Evidence from 1989 to 2010. Conference proceedings for the British Society of Rheumatology, ACR and EULAR between 2005 and 2009 were hand searched. Two reviewers assessed abstracts for inclusion and then quality of selected papers was assessed. Results. A total of 1840 abstracts were identified and 20 articles were suitable for inclusion. Information was obtained on the effect of TNF antagonists on overall CVD events, myocardial infarction, strokes and heart failure. Conclusion. In many studies, TNF antagonists appear to reduce the likelihood of CVD in individuals with RA. Reassuringly, there does not appear to be an increased risk of cardiac failure. However, the reduction in CVD is not as consistently seen as with studies of MTX.

类风湿性关节炎患者肿瘤坏死因子拮抗剂应用和心血管疾病的风险:系统文献复习

目的。RA与早期缺血性心脏病相关。很大程度上似乎是由于慢性炎症的存在。研究表明,疾病修饰药物如氨甲蝶呤(MTX)可以减少心血管事件的发生率。抗-TNF疗法能显著降低RA的炎症反应。然而,这些药物降低心血管疾病(CVD)的程度尚不明确。本研究目的是通过系统文献复习探讨抗-TNF药物对RA患者CVD的影响。方法。我们对1989年至2010年MEDLINE和EMBASE、循证医学科研数据库中、摘要和评论数据库,卫生技术评估、科学引文索引和临床证据进行索引，并手工检索了2005年至2009年英国风湿病协会、ACR和EULAR的会议论文集,索引目标为应用TNF拮抗剂治疗的RA患者记录心血管事件的成人研究。两个文献复习者对入选的文献进行评估,并评价其质量。结果。共有1840篇摘要和20篇文章适合入组。采集了TNF拮抗剂对总体心血管事件、心肌梗死、中风和心力衰竭影响的信息。结论。很多研究中,TNF拮抗剂似乎可以减少RA患者的CVD发生。令人放心的是,没有出现心脏衰竭增高的风险。然而,在MTX治疗的研究中减少心血管疾病的结果并不一致。