The Impact of Biologics and Tofacitinib on Cardiovascular Risk Factors and Outcomes in Patients with Rheumatic Disease: A Systematic Literature Review

Abstract

IntroductionRheumatic diseases are autoimmune, inflammatory diseases often associated with cardiovascular (CV) disease, a major cause of mortality in these patients. In recent years, treatment with biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs), either as monotherapy or in combination with other drugs, have become the standard of treatment. In this systematic literature review, we evaluated the effect of treatment with biologic or tofacitinib on the CV risk and outcomes in these patients.MethodsA systematic search was performed in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for articles reporting on CV risk and events in patients with rheumatic disease treated with a biologic agent or tofacitinib. Articles identified were subjected to two levels of screening. Articles that passed the first level based on title and abstract were assessed on full-text evaluation. The quality of randomized clinical trials was assessed by Jadad scoring system and the quality of the other studies and abstracts was assessed using the Downs and Black instrument. The data extracted included study design, baseline patient characteristics, and measurements of CV risk and events.ResultsOf the 5722 articles identified in the initial search, screening yielded 105 unique publications from 90 unique studies (33 clinical trials, 39 prospective cohort studies, and an additional 18 retrospective studies) that reported CV risk outcomes. A risk of bias analysis for each type of report indicated that they were of good or excellent quality. Importantly, despite some limitations in data reported, there were no indications of significant increase in adverse CV events or risk in response to treatment with the agents evaluated.ConclusionsTreatment with biologic or tofacitinib appears to be well-tolerated with respect to CV outcomes in these patients.Electronic supplementary materialThe online version of this article (10.1007/s40264-017-0628-9) contains supplementary material, which is available to authorized users.

Comparative Risk of Cardiovascular Events With Biologic and Synthetic Disease‐Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis: A Systematic Review and Meta‐Analysis

“…Our findings on the comparative risk of MACE and stroke with TNFi versus csDMARDs build upon previous meta‐analyses on the topic. Prior meta‐analyses have demonstrated that both TNFi and methotrexate are associated with a decreased risk of cardiovascular events, whereas exposure to NSAIDs and corticosteroids is associated with increased risk of cardiovascular events in patients with RA . However, these analyses have not compared cardiovascular risk with TNFi versus csDMARDs.…”

The metabolic effects of TNF inhibitors in rheumatoid arthritis patients

“…Data about IFX were quite controversial, but consistent with those obtained in our research. Thus, increases in TC, HDL-C and TG values were observed along with a less significant effect on LDL-C; serum CRP levels remained low during IFX therapy, as well as the rate of major cardiovascular events such as myocardial infarction or stroke [13].…”

“…Different studies have already evaluated the cardiovascular safety of TNFα inhibitors and other non-TNF drugs as well as their influence on cardiovascular risk factors in patients with active RA. Nurmohamed et al [13] evaluated the impact of individual TNF inhibitors on different risk factors; they concluded that ADA treatment did not show any effect on TC or TG values, while HDL cholesterol and LDL cholesterol showed slight increases. Moreover, ADA therapy resulted in a significant reduction in CRP level.…”

Efficacy and safety of tofacitinib for immune-mediated inflammatory rheumatic diseases (Part I)

“…Кардиоваскулярные осложнения на фоне лечения ТОФА развиваются редко [135][136][137]. Частота основных неблагоприятных сердечно-сосудистых событий (Major Cardiovascular Events -MAGE) составляет 0,2-0,7/100 ПГ.…”