The Effect of TNF alpha-Inhibitors on Cardiovascular Events in Patients with Rheumatoid Arthritis: An Updated Systematic Review of the Literature

Objectives: Rheumatoid arthritis (RA) is strongly associated with cardiovascular morbidity and mortality. Previous studies have demonstrated that TNF alpha-inhibitors may reduce cardiovascular events (CVE) in patients with RA. Thus, the purpose of this systematic review was to evaluate the ability of TNF alpha-inhibitors to reduce the risk of CVE in patients with RA. This study will update the findings of two earlier systematic reviews that synthesized the data up until 2010. Methods: A search of Medline, Embase, Medline In-Process and Other Non-Indexed Citations, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, and the Cochrane Central Register of Controlled Trials was conducted for observational studies reporting on CVE in RA patients since 2009. Conference proceedings for the Canadian Rheumatology Association, American College of Rheumatology, and European League against Rheumatism were also searched between 2009 and 2014. Abstracts were assessed for inclusion by two reviewers and studies identified by either reviewer were brought forward to full-text review. Studies undergoing full-text review were further assessed based on predefined inclusion and exclusion criteria and the quality of selected papers was evaluated using the Newcastle-Ottawa Scale. Results: The search identified 6089 abstracts and 14 articles were included in the final systematic review. Of the studies included, 8 reported on the effect of TNF alpha-inhibitors on overall CVE, 10 reported on coronary artery disease (CAD), 6 reported on cerebrovascular disease (CVD), and 5 reported other clinical cardiovascular outcomes. Conclusion: TNF alpha-inhibitors appear to reduce the likelihood of overall CVE in individuals with RA. The reduction is not as pronounced in the individual outcome measures. These results are consistent with two previous systematic reviews suggesting that TNF alpha-inhibitors are likely useful in the prevention of cardiovascular complications of RA.