(OTKA FK138696) Támogató: Hungarian National Research, Development and Innovation
Office
HCEMM TKP(TKP-2021-EGA-05) Támogató: NKFIH
HCEMM(2022-2.1.1-NL-2022-00005) Támogató: NKFIH
Immune‐mediated inflammatory disease (IMID) patients including psoriasis, inflammatory
arthritides and bowel diseases have a higher risk of developing cardiovascular (CV)
diseases compared to the general population. The increased CV risk may be promoted
by tumour necrosis factor (TNF)‐α‐mediated immunological processes, which are present
both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively
investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional
therapies in IMIDs. The systematic literature search was conducted in three databases
(MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials,
cohort and case–control studies were eligible for inclusion. Outcomes consisted of
the incidence of CV events, with major adverse cardiovascular events (MACE) as a main
endpoint. A random‐effects meta‐analysis was performed by pooling fully adjusted multivariate
hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval
(CI) comparing TNFis with conventional systemic non‐biologicals (CSNBs). Of a total
of 8724 search results, 56 studies were included overall, of which 29 articles were
eligible for the meta‐analysis, and 27 were involved in the systematic review. Including
all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with
the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58–0.95, p = 0.025; IRR
= 0.77, 95% CI 0.67–0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling
IRRs also confirmed the significantly decreased risk of MACE in TNFi‐treated patients
compared with CSNB groups (IRR = 0.79, 95% CI 0.64–0.98). The observational nature
of most included studies leading to high heterogeneity represents a limitation. Based
on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore,
earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence
may benefit CV risk in IMID patients.
