Upadacitinib and Cardiovascular Adverse Events in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Background: The safety of Upadacitinib, a Janus kinase inhibitor, in the context of rheumatoid arthritis management has raised concerns regarding potential cardiovascular adverse events, but the evidence remains inconclusive. Methods: Our study involved a systematic search for articles conducted up to October 1, 2023, encompassing databases such as PubMed/Medline, Embase, and Cochrane CENTRAL. We employed meta-analysis to calculate pooled odds ratios (OR) and their 95% confidence intervals (CI). We assessed potential publication bias through the application of Beggs and Eggers tests. Results: Six studies involving 4202 patients were included. The analysis of the 15 mg dosage revealed a pooled OR of 1.20 (95% CI: 0.3-4.3), indicating a small increase in cardiovascular adverse event likelihood without statistical significance. The 30 mg dosage analysis yielded a combined OR of 2.37 (95% CI: 0.6-9.1), suggesting a potential risk increase but lacking statistical significance. Beggs and Eggers tests indicated no publication bias. Conclusion: While there is a suggestion of elevated cardiovascular risk, especially with the 30 mg dosage, the absence of statistical significance and wide confidence intervals underscore the need for cautious interpretation. Individualized treatment decisions, vigilant monitoring, and further research are essential to optimize patient care and deepen our understanding of Upadacitinib safety profile.