A systematic literature search of MEDLINE (via PubMed), EMBASE and the Cochrane Library databases (1960 to December 2012) was performed to identify observational studies and randomised controlled trials that reported CVEs in adults with RA treated with biologics (including TNF inhibitors), non-biological DMARDs (including methotrexate), NSAIDs and corticosteroids. 28 references met the selection criteria for meta-analysis in RA (total of 236 525 subjects; 5410 CVEs). «Roubille C, Richer V, Starnino T ym. The effects o...»1
In RA, TNF inhibitors were significantly associated with a reduction in the risk of all CVEs (RR, 0.70; 95% CI 0.54 to 0.90; p=0.005), as well as in myocardial infarctions, strokes and major adverse cardiac events. No significant effect on heart failure was observed. A beneficial association between methotrexate and reduction in the risk of all CVEs (RR, 0.72; 95% CI 0.57 to 0.91; p=0.007) and myocardial infarction was also found.
Kommentti: Meta-analyysiin otetut tutkimukset olivat vuosilta 2002–2014, Niistä vanhimmat eivät välttämättä vastaa nykyisiä hoitokäytäntöjä. Meta-analyysistä suljettiin pois tutkimukset, joissa oli vähemmän kuin 400 tutkittavaa.
A cohort of patients who were started on their first biologic, a TNFi, between 2001 and 2010 (N = 7,704), and a cohort comprising matched biologic-naïve RA patient referents at a 3:1 ratio were indentified by linkage of the Swedish National Patient Register and the Swedish Biologics Register. Furthermore, a matched comparator cohort (5:1 ratio) was extracted from the Swedish population register. «Ljung L, Askling J, Rantapää-Dahlqvist S ym. The r...»2
Based on 221 events in 7,704 patients (comprising 32,621 person-years) treated with TNFi biologics, the hazard ratio ((HR); ever-exposed) for acute coronary syndrome among the TNFi-exposed RA patients compared with biologic-naïve RA patients was 0.8 (95% confidence interval (CI) = 0.7 to 0.95). In comparison with the general population referents, statistical analysis using fully adjusted models resulted in a HR of 2.0 (95% CI = 1.8 to 2.3) for biologic-naïve RA patients and a HR of 1.6 (95% CI = 1.4 to 1.9) for the TNFi-exposed group.
Kommentti: Seuranta-aika oli varsin lyhyt.