Tumor Necrosis-α Factor Inhibitors For Reducing Cardiovascular Complication In Rheumatoid Arthritis：a Systematic Review

Objective: To qualitatively and quantitatively analysis therelationship between TNF-α inhibitor treatment and cardiovascularcomplications in rheumatoid arthritis.Methods: Defined the research subject，formulated the inclusioncriterion and exclusion criterion． In accordance with the inclusion andexclusion criterion, draw up an appropriate search strategy to collectrelational literatures. A search of MEDLINE, Embase, CNKI,WANFANG and VIP Database was undertaken to identify case-controlstudies or cohort studies evaluating the risk of cardiovascular events inTNF-α inhibitor users and nonusers before January2014. And we alsosearched correlative meeting literatures and other unpublished articles.Arranged the included literatures, extracted related data and assess theirquality. We then assessed heterogeneity between studies, onlyhomogeneous data could be combined. If the heterogeneity betweenstudies was too large, we used subgroup analysis and sensitivity analysisto search for the source of heterogeneity or gave a descriptive analysis. Potential publication bias was tested by Begg funnel plot and Egger test.Stata12.0software was used for stata analysis.Results: Nineteen studies were identified, including fourteen cohortstudies and five case-control studies. In this meta analysis, the risk oftotal cardiovascular events reduced by33％in TNF-α inhibitor users ascompared with nonusers in RA(RR=0.67,95%CI0.52to0.86), the riskof stroke reduced by19%(RR=0.81,95%CI0.7to0.93). There was nosignificant difference between the two groups in reducing congestiveheart failure (RR=0.98,95%CI0.86to1.11) and all-cause mortality(RR=0.83,95%CI0.67to1.02). Due to the clinical heterogeneity betweenstudies on whether applying TNF-α inhibitor can reduce the incidence ofischemic heart disease, we only gave descriptive analysis that usingTNF-α inhibitor do not increase the incidence of ischemic heart disease.Conclusion: This meta-analysis suggests that anti-TNF-α therapy isassociated with a reduced risk of overall cardiovascular events and stroke,without an increased risk of congestive heart failure, ischemic heartdisease and all-cause mortality. Stricter clinical trials are needed toexclude confounding factors.