The Biological Disease-Modifying Antirheumatic Drugs and the Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis

Hu, Suiyuan; Lin, Chu; Cai, Xiaoling; Zhu, Xiaoxi; Lv, Fang; Lin, Na

doi:10.1155/2021/7712587

Cited by 19 publications

(16 citation statements)

References 40 publications

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“…Although cardiovascular events were major concern among RA patients [28], only one case of cardiovascular event that led to treatment cessation was observed in our study. This may support previous ndings of reduced risks of cardiovascular events among b/tsDMARD users [29], though this may also due to short observational period of one year.…”

Section: Discussionsupporting

confidence: 90%

Preferable Outcome of Janus Kinase Inhibitors For a Group of Difficult-to-Treat Rheumatoid Arthritis Patients: From The FIRST Registry

Ochi

Sonomoto

Nakayamada

et al. 2021

Preprint

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Backgrounds：Treatment of difficult-to-treat rheumatoid arthritis (D2T-RA) is one of the greatest unmet needs in rheumatology. This study aims to find out preferable treatment option for a group of D2T-RA patient who are refractory to multiple biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs).Methods: Data were obtained from patients enrolled in the FIRST registry who started either TNF-inhibitor (TNFi), interleukin-6 receptor inhibitor, cytotoxic T-lymphocyte-associated antigen-4 immunoglobulin, or Janus-kinase inhibitor (JAKi) in the period of August 2013 - December 2020. Those who failed to ≥2 and ≥3 b/tsDMARDs were categorised as D2T-RA and very D2T-RA (vD2T-RA), respectively. Change in clinical disease activity index (CDAI) and health assessment questionnaire disability index were compered among groups using propensity-based inverse-probability treatment weighted (IPTW) method. Results: Of 2,128cases included, 353 were categorised as D2T-RA. Among the D2T-RA, 106 were identified as vD2T-RA. JAKi showed significant improvement in CDAI in the patients with D2T-RA and vD2T-RA, compared to IPTW-adjusted patients treated with the other 3 regimens. Latent class analysis of the trajectories of treatment response revealed that the proportion of a group of patients who showed poor response was lower among JAKi subgroup than those with other subgroups. This superiority of JAKi was more apparent among in methotrexate- and glucocorticoid-free individuals. Hazard ratio of severe adverse events were comparable among the four treatment subgroups in both the D2T-RA and b/tsDMARD-naïve groups.Conclusions: This study compared responsiveness to different classes of b/tsDMARDs among D2T-RA and vD2T-RA patients who were refractory to multiple b/tsDMARDs. The results suggest JAKi is a preferable treatment choice for this type of D2T-RA.

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Section: Discussionsupporting

confidence: 90%

Preferable Outcome of Janus Kinase Inhibitors For a Group of Difficult-to-Treat Rheumatoid Arthritis Patients: From The FIRST Registry

Ochi

Sonomoto

Nakayamada

et al. 2021

Preprint

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“…[ 11 ] However, a meta-analysis published recently indicated that the use of bDMARDs might be associated with the reduced risks of cardiovascular death in RA. [ 97 ] Different retrieval methods and calculation methods may lead to different results. More investigations are needed to validate conclusions.…”

Section: Discussionmentioning

confidence: 99%

Biologic DMARDs and targeted synthetic DMARDs and the risk of all-cause mortality in rheumatoid arthritis: A systematic review and meta-analysis

2022

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Background: The aim of this study was to perform a meta-analysis to compare the risk of all-cause mortality between biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) and non-b/tsDMARDs involving patients with rheumatoid arthritis (RA). Methods: We performed a systematic review of articles published up to August 2021 using electronic databases. We included studies that reported all-cause mortality in RA patients and compared b/tsDMARDs and non-b/tsDMARDs. Results: We included a total of 77 studies involving 64,428 patients. These comprised 44,227 patients treated with b/tsDMARDs and 20,201 treated with non-b/tsDMARDs. The occurrence of all-cause mortality was the primary outcome. The risk of all-cause mortality between the 2 treatments was not significantly different (relative risk = 1.08; 95% confidence interval = 0.98–1.19). However, subgroup analyses showed significant increase in risks of mortality in anti-TNFs users with RA compared with non-b/tsDMARDs (relative risk = 1.47, 95% confidence interval = 1.02–2.12). No significant differences were found after subgroup analyses based on other molecules involved and study duration. Conclusion: In comparison with non-b/tsDMARDs, our results suggest that antitumor necrosis factor therapy is associated with observed increased risks of mortality and further investigation is needed.

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“…Biologic disease-modifying therapies (bDMARDs) should be further investigated. Hu et al found a reduced risk of MI (OR 0.74, 95% CI 0.63-0.87), cardiovascular death (OR 0.62, 95% CI 0.40-0.95), and a composite endpoint of MI, stroke, and cardiovascular death (OR 0.69, 95% CI 0.53-0.89) in those on bDMARDs, compared with those not on bDMARDs [98]. These finding were mostly driven by the reduction of risk in rheumatoid arthritis patients, thus the role in SLE is unclear.…”

Section: Antiatherosclerotic Therapies In Slementioning

confidence: 99%

Accelerated Atherosclerosis in SLE: Mechanisms, Consequences, and Future Directions

Semalulu¹,

Tselios²

2023

Systemic Lupus Erythematosus - Pathogenesis and Management

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The bimodal mortality rate in systemic lupus erythematosus (SLE) has been well documented, with atherosclerosis identified as a leading cause of late-stage death. Multiple mechanisms are responsible for accelerated atherosclerosis in SLE, ultimately resulting in endothelial dysfunction, arterial stiffness, arterial wall thickening, and plaque formation. This leads to an increased risk of coronary artery disease, cardiovascular events, cerebrovascular accidents, and peripheral arterial disease. SLE patients are not only impacted by traditional risk factors for cardiovascular disease (age, smoking, dyslipidemia, diabetes), but additionally nontraditional risk factors (prolonged corticosteroid use, disease activity and chronic inflammation). Identifying the impact of traditional risk factors and mediating nontraditional risk factors in SLE are vital to reduce morbidity and mortality related to atherosclerosis. SLE-specific screening methods should be established in the routine care of these patients, including the use of validated modified risk scores and imaging modalities. Furthermore, the utility of disease-specific biomarkers and anti-atherosclerotic therapies should be elicited. This chapter will provide an overview of considerations for the mechanisms, impact, and prevention of atherosclerosis in SLE patients.

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The Biological Disease-Modifying Antirheumatic Drugs and the Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis

Cited by 19 publications

References 40 publications

Preferable Outcome of Janus Kinase Inhibitors For a Group of Difficult-to-Treat Rheumatoid Arthritis Patients: From The FIRST Registry

Preferable Outcome of Janus Kinase Inhibitors For a Group of Difficult-to-Treat Rheumatoid Arthritis Patients: From The FIRST Registry

Biologic DMARDs and targeted synthetic DMARDs and the risk of all-cause mortality in rheumatoid arthritis: A systematic review and meta-analysis

Accelerated Atherosclerosis in SLE: Mechanisms, Consequences, and Future Directions

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