4.1 TNF- ANTAGONISTS IMPROVE ARTERIAL STIFFNESS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A META-ANALYSIS

Abstract

Purpose/Background/Objectives: Patients with rheumatoid arthritis (RA) have a higher arterial stiffness than their age-matched healthy counterparts and an increased inflammatory burden that might be associated with their increased cardiovascular risk. Tumor necrosis factor alpha (TNF)-antagonists have been found to reduce inflammatory markers in RA however it is debatable if they have favorable effects on surrogate markers of cardiovascular outcomes. We conducted a meta-analysis to assess the effect of TNF-antagonists on arterial stiffness, a predictor of cardiovascular events and mortality, in RA patients. Methods: A search of PUBMED was conducted to identify studies into the effect of TNF-antagonists on arterial stiffness in RA patients. Data were available on 3 TNF-antagonists: infliximab, adalimumab, and etanercept. Results: 10 studies (n=208 patients) out of 14 eligible studies in total, measured changes in carotid-femoral PWV after treatment with anti-TNFs. Subjects under therapy with anti-TNFs significantly decreased their arterial stiffness (mean change in PWV: -0.53 m/s, p=0.001)(Figure). No significant heterogeneity was observed across the studies (I2=8.5%, p=0.364). By subgroup analysis, improvement in PWV after therapy was independent of age, sex, nationality and clinical response to treatment and dependent of the type of the TNF- antagonist used. Conclusions: The balance of evidence suggests that TNF-antagonists may have a beneficial effect on arterial stiffness in RA patients. Given the predictive role of aortic stiffness for adverse cardiovascular outcomes, TNF-antagonists might confer reduction of the cardiovascular risk of these patients beyond their anti-inflammatory effect. However, larger longitudinal studies are warranted to confirm recent findings.