The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis

Abstract

The objective of this systematic literature review was to determine the association between cardiovascular events (CVEs) and antirheumatic drugs in rheumatoid arthritis (RA) and psoriatic arthritis (PsA)/psoriasis (Pso).Systematic searches were performed of MEDLINE, EMBASE and Cochrane databases (1960 to December 2012) and proceedings from major relevant congresses (2010–2012) for controlled studies and randomised trials reporting confirmed CVEs in patients with RA or PsA/Pso treated with antirheumatic drugs. Random-effects meta-analyses were performed on extracted data.Out of 2630 references screened, 34 studies were included: 28 in RA and 6 in PsA/Pso. In RA, a reduced risk of all CVEs was reported with tumour necrosis factor inhibitors (relative risk (RR), 0.70; 95% CI 0.54 to 0.90; p=0.005) and methotrexate (RR, 0.72; 95% CI 0.57 to 0.91; p=0.007). Non-steroidal anti-inflammatory drugs (NSAIDs) increased the risk of all CVEs (RR, 1.18; 95% CI 1.01 to 1.38; p=0.04), which may have been specifically related to the effects of rofecoxib. Corticosteroids increased the risk of all CVEs (RR, 1.47; 95% CI 1.34 to 1.60; p<0.001). In PsA/Pso, systemic therapy decreased the risk of all CVEs (RR, 0.75; 95% CI 0.63 to 0.91; p=0.003).In RA, tumour necrosis factor inhibitors and methotrexate are associated with a decreased risk of all CVEs while corticosteroids and NSAIDs are associated with an increased risk. Targeting inflammation with tumour necrosis factor inhibitors or methotrexate may have positive cardiovascular effects in RA. In PsA/Pso, limited evidence suggests that systemic therapies are associated with a decrease in all CVE risk.

Systemischer Lupus erythematodes

“…In der Regel reichen dafür 0,5 mg/kg täglich aus. Aufgrund der hohen Langzeittoxizität und insbesondere des negativen Einflusses auf Infektionen [15] und kardiovaskuläres Risiko [16,17] sollte die Dosis nicht längerfristig auf > 5 mg Prednisolonäquivalent täglich belassen werden. Wenn die Krankheitsaktivität mehr erforderlich macht, sollten stattdessen Methotrexat (MTX), Azathioprin oder Belimumab eingesetzt werden.…”

Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations

“…In a longitudinal United States cohort, reduction in disease activity paralleled the reduction in CV events independently of antirheumatic treatments [Solomon et al 2015b]. In a meta-analysis, methotrexate and TNF-inhibitors were shown to decrease CV events by a third [Roubille et al 2015]. The impact of anti-rheumatic treatments on lipid profile and CV risk has been well studied.…”

“…On the other hand, by reducing systemic inflammation, they could decrease CV risk. A recent meta-analysis demonstrated a significant increase in CV events with glucocorticosteroids (OR 1.47; 95% CI 1.34-1.60), whether for MI (OR 1.41; 95% CI 1.22-1.63), stroke (OR 1.57; 95% CI 1.05-2.35), or congestive heart failure (OR 1.42; 95% CI 1.10-1.82) [Roubille et al 2015]. Glucocorticosteroids were shown to be associated with an increased MI risk in RA, in a dose-and duration-dependent manner [Aviña-Zubieta et al 2013].…”

“…In RA, the risk of vascular events was also increased with NSAIDs, but the increase in vascular risk was statistically significant only for cyclooxygenase-2 inhibitors [Roubille et al 2015]. In AS, the use of NSAIDs might reduce the risk of CV disease [Tsai et al 2015].…”

Validation of Self-Reported Cardiovascular Disease and Associated Co- Morbidities in a Large Canadian Cohort of Early Inflammatory Arthritis

“…In addition, RA patients have higher rates of risk factors for CVD, including cigarette smoking, hypertension, diabetes mellitus, obesity and dyslipidemia [3,4]. The treatment of RA involves exposure to medications known to increase CVD risk: corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) [5]. Therefore, studying cardiovascular associated co-morbidities and treatment is critical for determining ways to improve outcomes in RA.…”