Dr. Barnabe has received speaking fees and/or honoraria (less than $10,000 each) from Abbott and Amgen/Wyeth.
Special Theme Articles: Vascular Comordibidity in the Rheumatic Diseases
Systematic review and meta-analysis: Anti–tumor necrosis factor α therapy and cardiovascular events in rheumatoid arthritis
Article first published online: 30 MAR 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 4, pages 522–529, April 2011
How to Cite
Barnabe, C., Martin, B.-J. and Ghali, W. A. (2011), Systematic review and meta-analysis: Anti–tumor necrosis factor α therapy and cardiovascular events in rheumatoid arthritis. Arthritis Care Res, 63: 522–529. doi: 10.1002/acr.20371
- Issue published online: 30 MAR 2011
- Article first published online: 30 MAR 2011
- Accepted manuscript online: 18 OCT 2010 01:08PM EST
- Manuscript Accepted: 4 OCT 2010
- Manuscript Received: 7 MAY 2010
- UCBeyond-The Arthritis Society-Canadian Rheumatology Association Post-Graduate Rheumatology Fellowship
- Canadian Institutes of Health Research
- Government of Canada Research Chair in Health Services Research
- Senior Health Scholar award from the Alberta Heritage Foundation for Medical Research
Control of rheumatoid arthritis (RA) may reduce the risk of cardiovascular events. We sought to systematically assess the association between anti–tumor necrosis factor α (anti-TNFα) therapy in RA and cardiovascular event rates.
Observational cohorts and randomized controlled trials (RCTs) reporting on cardiovascular events (all events, myocardial infarction [MI], congestive heart failure, and cerebrovascular accident [CVA]) in RA patients treated with anti-TNFα therapy compared to traditional disease-modifying antirheumatic drugs were identified from a search of PubMed (1950 to November 2009), EMBase (1980 to November 2009), and conference abstracts. Relative risks (RRs) or hazard ratios and 95% confidence intervals (95% CIs) were extracted. If the incidence was reported, additional data were extracted to calculate an incidence density ratio and its variance.
The systematic review and meta-analysis include 16 and 11 publications, respectively. In cohort studies, anti-TNFα therapy was associated with a reduced risk for all cardiovascular events (pooled adjusted RR 0.46; 95% CI 0.28, 0.77), MI (pooled adjusted RR 0.81; 95% CI 0.68, 0.96), and CVA (pooled adjusted RR 0.69; 95% CI 0.53, 0.89). Meta-analysis of RCTs also produced a point estimate indicating lower risk of cardiovascular events, but this was not statistically significant (pooled RR 0.85; 95% CI 0.28, 2.59).
Anti-TNFα therapy is associated with a reduced risk of all cardiovascular events, MI, and CVA in observational cohorts. There was heterogeneity among cohort studies and possible publication bias. The point estimate of the effect from RCTs is underpowered with wide 95% CIs, and cardiovascular events were secondary outcomes, but RCTs also demonstrated a trend toward decreased risk.