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

Table 3

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

Endpoint	Subgroup		Participant (bDMARD/control)	OR	95% CI	value
Cardiovascular death
	Total		15815/10957	0.62	0.40, 0.95	0.03	0
	Study type	Cohort	10688/8086	0.40	0.23, 0.69	0.001	0
		RCT	5127/2871	1.54	0.69, 3.46	0.29	0
	Disease type	RA	13361/9636	0.60	0.38, 0.96	0.03	4
		Ps	2177/1052	0.71	0.18, 2.85	0.63	0
		SLE	277/269	0.97	0.06, 15.60	0.98	NA
	Drug type	TNF-α inhibitor	12832/9102	0.53	0.33, 0.86	0.01	0
		IL-17 inhibitor	103/22	0.07	0.00, 1.76	0.11	NA
		IL-12/23 inhibitor	1801/894	1.49	0.16, 14.37	0.73	0
		IL-6 receptor inhibitor	288/284	4.97	0.24, 103.88	0.30	NA
		B cell inhibition	277/269	0.97	0.06, 15.60	0.98	NA
		T cell inhibition	514/386	2.17	0.23, 20.91	0.50	0
	Follow-up duration	>1 year	12629/9116	0.46	0.28, 0.77	0.003	0
		<1 year	3186/1841	1.62	0.62, 4.20	0.32	0
	Previous CVD	<30%	9368/6754	0.58	0.25, 1.38	0.22	0
		30-50%	981/484	1.48	0.06, 36.46	0.81	NA
	Diabetes	<30% (all available studies)	10880/7781	0.42	0.21, 0.83	0.01	0
	Hypertension	<30%	9368/6754	0.58	0.25, 1.38	0.22	0
		30-50%	981/484	1.48	0.06, 36.46	0.81	NA
	Dyslipidemia	<30%	9368/6754	0.58	0.25, 1.38	0.22	0
		>50%	981/484	1.48	0.06, 36.46	0.81	NA

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.