NEW YORK (Reuters Health) – For patients with rheumatoid arthritis (RA), treatment with anti-tumor necrosis factor (TNF) agents appears to reduce their risk of cardiovascular events, including MI and stroke, according to a new meta-analysis reported in Arthritis Care & Research online October 18.

However, the authors caution that some of the pooled results from randomized clinical trials are not definitive.

Dr. Cheryl Barnabe and colleagues at the University of Calgary, Alberta, Canada point out that increased cardiovascular (CV) risk in patients with rheumatoid arthritis has become widely recognized, and treatment that reduces inflammatory burden may reduce that risk. In fact, they note, “a recent systematic review identified the beneficial effect of methotrexate on CV event rates.”

To look at the effects of anti-TNF treatment, the researchers reviewed evidence from two sources – observational cohort studies and randomized clinical trials (RCTs). They ultimately identified 13 cohort studies (106,202 patients) and 3 RCTs (2,126 patients) that met inclusion criteria. After data extraction, 8 cohort studies and the 3 RCTs were found acceptable for meta-analysis.

From the cohort studies, anti-TNF therapy was associated with significantly reduced risks for all CV events (pooled adjusted RR 0.46), for MI (pooled adjusted RR 0.81), and for cerebrovascular accident (pooled adjusted RR 0.69).

Meta-analysis of the three RCTs produced a pooled RR of 0.85 for CV event rates with anti-TNF therapy compared to DMARD (disease-modifying anti-rheumatic drug) therapy, but this was not statistically significant.

“In summary,” Dr. Barnabe and colleagues write, “we identified that RA treatment with anti-TNF therapy is likely associated with a reduced risk of CV events, a finding that is supported by clear biological plausibility.”

The effect of anti-TNF therapy may become clearer with longer follow-up, they add. “It is possible that with longer observation, a more pronounced treatment effect on reducing CV events will be discovered, as many of the people who are currently treated with anti-TNF therapies are relatively young and may not face CV morbidity for several years to come.”

Reference:

Systematic review and meta-analysis: Anti-tumor necrosis factor alpha therapy and cardiovascular events in rheumatoid arthritis

Arthritis Rheum 2010.