The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis

被引:671
作者
Roubille, Camille [1 ]
Richer, Vincent [2 ]
Starnino, Tara [3 ]
McCourt, Collette [4 ]
McFarlane, Alexandra [5 ]
Fleming, Patrick [6 ]
Siu, Stephanie [7 ]
Kraft, John [8 ]
Lynde, Charles [8 ]
Pope, Janet [7 ]
Gulliver, Wayne [9 ]
Keeling, Stephanie [5 ]
Dutz, Jan [4 ]
Bessette, Louis [10 ]
Bissonnette, Robert [11 ]
Haraoui, Boulos [12 ,13 ]
机构
[1] Univ Montreal Hosp Res Ctr CRCHUM, Notre Dame Hosp, Montreal, PQ, Canada
[2] St Luc Hosp, Dept Med, Dermatol Serv, Montreal, PQ, Canada
[3] Univ Montreal, Sacre Coeur Hosp Montreal, Montreal, PQ, Canada
[4] Univ British Columbia, Dept Dermatol & Skin Sci, Vancouver, BC V5Z 1M9, Canada
[5] Univ Alberta, Div Rheumatol, Edmonton, AB, Canada
[6] Univ Toronto, Div Dermatol, Toronto, ON, Canada
[7] Western Univ Canada, Dept Med, St Josephs Hlth Care, Div Rheumatol, London, ON, Canada
[8] Lynde Dermatol, Markham, ON, Canada
[9] Mem Univ Newfoundland, Fac Med, St John, NF, Canada
[10] Univ Laval, Dept Med, Ctr Rech, CHU Quebec, Quebec City, PQ G1K 7P4, Canada
[11] Innovaderm Res, Montreal, PQ, Canada
[12] CHUM, Rheumat Dis Unit, Dept Med, Montreal, PQ, Canada
[13] Inst Rhumatol Montreal, Montreal, PQ H2L 1S6, Canada
关键词
CONGESTIVE-HEART-FAILURE; FACTOR-ALPHA THERAPY; MODIFYING ANTIRHEUMATIC DRUGS; MYOCARDIAL-INFARCTION; BRITISH-SOCIETY; RISK-MANAGEMENT; ALL-CAUSE; DISEASE; MORTALITY; GLUCOCORTICOIDS;
D O I
10.1136/annrheumdis-2014-206624
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The objective of this systematic literature review was to determine the association between cardiovascular events (CVEs) and antirheumatic drugs in rheumatoid arthritis (RA) and psoriatic arthritis (PsA)/psoriasis (Pso). Systematic searches were performed of MEDLINE, EMBASE and Cochrane databases (1960 to December 2012) and proceedings from major relevant congresses (2010-2012) for controlled studies and randomised trials reporting confirmed CVEs in patients with RA or PsA/Pso treated with antirheumatic drugs. Random-effects meta-analyses were performed on extracted data. Out of 2630 references screened, 34 studies were included: 28 in RA and 6 in PsA/Pso. In RA, a reduced risk of all CVEs was reported with tumour necrosis factor inhibitors (relative risk (RR), 0.70; 95% CI 0.54 to 0.90; p=0.005) and methotrexate (RR, 0.72; 95% CI 0.57 to 0.91; p=0.007). Non-steroidal anti-inflammatory drugs (NSAIDs) increased the risk of all CVEs (RR, 1.18; 95% CI 1.01 to 1.38; p=0.04), which may have been specifically related to the effects of rofecoxib. Corticosteroids increased the risk of all CVEs (RR, 1.47; 95% CI 1.34 to 1.60; p<0.001). In PsA/Pso, systemic therapy decreased the risk of all CVEs (RR, 0.75; 95% CI 0.63 to 0.91; p=0.003). In RA, tumour necrosis factor inhibitors and methotrexate are associated with a decreased risk of all CVEs while corticosteroids and NSAIDs are associated with an increased risk. Targeting inflammation with tumour necrosis factor inhibitors or methotrexate may have positive cardiovascular effects in RA. In PsA/Pso, limited evidence suggests that systemic therapies are associated with a decrease in all CVE risk.
引用
收藏
页码:480 / 489
页数:10
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