Mediators of Inflammation

Review Article

The Biological Disease-Modifying Antirheumatic Drugs and the Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis

Table 1

Sensitivity analyses for the use of bDMARD and incidence of myocardial infarction in patients with systemic inflammatory conditions.


Endpoint	Subgroup		Participant (bDMARD/control)	OR	95% CI	value

Myocardial infarction
	Total		57989/30207	0.74	0.63, 0.87	0.002	0
	Study type	Cohort	45040/24148	0.63	0.43, 0.91	0.01	66
	Study type	RCT	12949/6059	0.79	0.47, 1.31	0.36	0
	Disease type	RA	49510/26524	0.74	0.63, 0.87	0.0004	31
		Ps	6324/2675	0.90	0.45, 1.80	0.77	0
		SLE	2155/1008	0.49	0.19, 1.28	0.14	0
	Drug type	TNF-α inhibitor	49141/26344	0.74	0.63, 0.88	0.0006	27
		IL-17 inhibitor	2358/627	0.31	0.10, 1.00	0.05	3
		IL-23 inhibitor	1046/378	1.25	0.20, 7.94	0.82	0
		IL-12/23 inhibitor	1824/873	1.30	0.33, 5.21	0.71	0
		IL-6 receptor inhibitor	1209/724	1.48	0.35, 6.33	0.60	23
		B cell inhibition	2155/1008	0.49	0.19, 1.28	0.14	0
		T cell inhibition	256/253	0.33	0.01, 8.09	0.50	NA
	Follow-up duration	>1 year	38143/17825	0.73	0.61, 0.87	0.0006	37
	Follow-up duration	<1 year	19846/12382	0.78	0.55, 1.11	0.17	0
	Previous CVD	<30%	42707/21393	0.78	0.63, 0.96	0.02	34
	Previous CVD	30-50%	981/484	3.47	0.18, 67.23	0.41	NA
	Diabetes	<30%	44874/24045	0.61	0.42, 0.88	0.009	68
	Diabetes	30-50%	981/484	3.47	0.18, 67.23	0.41	NA
	Hypertension	<30%	29227/11982	0.66	0.39, 1.11	0.12	60
	Hypertension	30-50%	16097/12004	0.77	0.59, 1.01	0.06	0
	Dyslipidemia	<30%	9368/6754	0.27	0.11, 0.62	0.002	0
		30-50%	11587/8656	0.77	0.49, 1.20	0.24	NA
		>50%	12568/9140	0.81	0.52, 1.25	0.34	0

Previous cardiovascular disease includes ischemia heart disease, coronary heart disease, angina, myocardial infarction, congestive heart failure, atrial fibrillation, and cerebrovascular disease. bDMARD: biological disease-modifying antirheumatic drug; CVD: cardiovascular disease; IFN: interferon; IL: interleukin; MACE: major adverse cardiovascular event; NA: not applicable; Ps: psoriasis; RCT: randomized controlled trial; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus; TNF: tumor necrosis factor.