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

Table 4

Sensitivity analyses for the use of bDMARD and all-cause mortality in patients with systemic inflammatory conditions.

Endpoint	Subgroup		Participant (bDMARD/control)	OR	95% CI	value
All-cause mortality
	Total		44701/43453	0.64	0.58, 0.70	<0.0001	38
	Study type	Cohort	32202/36930	0.60	0.44, 0.82	0.002	82
		RCT	12499/6523	0.91	0.61, 1.35	0.65	0
	Disease type	RA	36704/39412	0.64	0.49, 0.85	0.002	63
		Ps	36677/1719	0.80	0.26, 2.45	0.70	0
		SLE	4330/2322	0.93	0.54, 1.59	0.79	0
	Drug type	TNF-α inhibitor	35879/38727	0.63	0.47, 0.84	0.002	66
		IL-6 receptor inhibitor	1159/848	1.36	0.43, 4.31	0.60	0
		IL-17 inhibitor	103/22	0.07	0.00, 1.76	0.11	NA
		IL-23 inhibitor	915/254	0.87	0.09, 8.43	0.91	0
		IL-12/23 inhibitor	1801/894	1.49	0.16, 14.3	0.73	0
		B cell inhibition	3952/2040	1.11	0.59, 2.09	0.74	0
		T cell inhibition	712/486	0.53	0.22, 1.28	0.16	0
		IFN receptor antibody	180/182	3.05	0.12, 75.37	0.50	NA
	Follow-up duration	>1 year	27480/31921	0.62	0.48, 0.80	0.0002	42
		<1 year	17221/11532	1.02	0.77, 1.35	0.90	0
	Previous CVD	<30%	27880/15353	0.81	0.69, 0.95	0.01	15
		30-50%	4777/20383	0.58	0.51, 0.67	<0.0001	0
		>50%	225/808	0.92	0.56, 1.51	0.75	NA
	Diabetes	<30%	27289/15334	0.68	0.40, 1.14	0.14	80
		30-50%	5002/21191	0.68	0.47, 0.98	0.04	0
	Hypertension	<30%	11642/3271	1.19	0.40, 3.55	0.75	NA
		30-50%	16097/12004	0.80	0.68, 0.94	0.007	39
		>50%	4021/20707	0.69	0.45, 1.06	0.09	68
	Dyslipidemia	30-50%	3529/2864	0.72	0.59, 0.88	0.001	NA
		>50%	116589/29847	0.80	0.53, 1.19	0.26	76

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.