Effect of TNF-alpha inhibitor on subclinical atherosclerosis in rheumatoid arthritis patients: a meta-analysis

INTRODUCTION: Tumour necrosis factor (TNF)–alpha inhibitors are a class of biological disease–modifying antirheumatic drug for the treatment of rheumatoid arthritis. It is well-known that patients with rheumatoid arthritis have higher cardiovascular risks. However, the effects of TNF-alpha inhibitors on subclinical atherosclerosis have not been confirmed in clinical studies due to contradictory results. Therefore, a meta-analysis is required to assess the overall effect of TNF-alpha inhibitors on subclinical atherosclerosis. METHODS: We searched for publications and recent rheumatology abstracts in PubMed, EMBase, Cochrane Database of Systematic Reviews, and ISI Web of Science. For inclusion, studies must report at least one of the variables of subclinical atherosclerosis, ie carotid intimal media thickness, pulse wave velocity, and augmentation index before and after treatment. Results were analysed by RevMan v5.3.5 using random effects model. RESULTS: A 24-week treatment with TNF-alpha inhibitors was not associated with improvements in carotid intimal media thickness (standardised mean difference [SMD], 0.28; 95% confidence interval [CI], 0.08-0.48), augmentation index (SMD, -0.05; 95% CI, -0.49 to -0.38) or pulse wave velocity (SMD, -0.30; 95% CI, -0.97 to -0.36). However, 52-week treatment of TNF-alpha inhibitors yielded a significant improvement in carotid intimal media thickness (SMD, 0.03; 95% CI, -0.41 to -0.48). CONCLUSION: There was no significant improvement in subclinical atherosclerosis in patients with rheumatoid arthritis treated with TNF-alpha inhibitors, which could be due to short assessment period. Therefore, longterm studies are advised to further evaluate the effect of TNF-alpha inhibitors on subclinical atherosclerosis