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

Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review
Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review
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.
rheumatoid arthritis, tumour necrosis factor antagonists, cardiovascular disease, inflammation and systematic literature review
1462-0324
518-531
Westlake, Sarah L.
e16d25fb-81f5-473c-b564-07256fc6d3a7
Colebatch, Alexandra N.
9739b630-ba0f-45b1-b2ad-f176faf2d909
Baird, Janis
f4bf2039-6118-436f-ab69-df8b4d17f824
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kiely, Patrick
7d818b1c-d717-49cc-b1d5-21ae0acf08d7
Quinn, Mark
e811515c-046b-4d5b-b13a-76a715bbc090
Choy, Ernest
140fe55e-3fa1-433d-9995-b72c7cee464e
Ostor, Andrew J.K.
618e25fd-5d6b-47e0-8ee0-fba579618766
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106
Westlake, Sarah L.
e16d25fb-81f5-473c-b564-07256fc6d3a7
Colebatch, Alexandra N.
9739b630-ba0f-45b1-b2ad-f176faf2d909
Baird, Janis
f4bf2039-6118-436f-ab69-df8b4d17f824
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Kiely, Patrick
7d818b1c-d717-49cc-b1d5-21ae0acf08d7
Quinn, Mark
e811515c-046b-4d5b-b13a-76a715bbc090
Choy, Ernest
140fe55e-3fa1-433d-9995-b72c7cee464e
Ostor, Andrew J.K.
618e25fd-5d6b-47e0-8ee0-fba579618766
Edwards, Christopher J.
dcb27fec-75ea-4575-a844-3588bcf14106

Westlake, Sarah L., Colebatch, Alexandra N., Baird, Janis, Curzen, Nick, Kiely, Patrick, Quinn, Mark, Choy, Ernest, Ostor, Andrew J.K. and Edwards, Christopher J. (2011) Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology, 50 (3), 518-531. (doi:10.1093/rheumatology/keq316). (PMID:21071477)

Record type: Article

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.

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More information

Published date: 1 March 2011
Keywords: rheumatoid arthritis, tumour necrosis factor antagonists, cardiovascular disease, inflammation and systematic literature review

Identifiers

Local EPrints ID: 177419
URI: http://eprints.soton.ac.uk/id/eprint/177419
ISSN: 1462-0324
PURE UUID: b87a9a3c-500a-4508-b11a-6b4a6d792c4a
ORCID for Janis Baird: ORCID iD orcid.org/0000-0002-4039-4361
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

Catalogue record

Date deposited: 17 Mar 2011 14:15
Last modified: 14 Mar 2024 02:50

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Contributors

Author: Sarah L. Westlake
Author: Alexandra N. Colebatch
Author: Janis Baird ORCID iD
Author: Nick Curzen ORCID iD
Author: Patrick Kiely
Author: Mark Quinn
Author: Ernest Choy
Author: Andrew J.K. Ostor

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