Rheumatology Department, Gabriel-Montpied University Hospital, Clermont-Ferrand, France.
HESPER EA 7425, University of Lyon, Claude Bernard University Lyon 1, Lyon, France.
PLoS One. 2019 Aug 1;14(8):e0220178. doi: 10.1371/journal.pone.0220178. eCollection 2019.
Our objective was to compare the cardiovascular safety of tocilizumab and other biological disease-modifying antirheumatic drugs (bDMARD) in rheumatoid arthritis using a network meta-analysis (NMA).
A systematic literature search through May 2018 identified randomized controlled trials (RCT) or observational studies (cohort only) reporting cardiovascular outcomes of tocilizumab (TCZ) and/or abatacept (ABA) and/or rituximab (RTX) and/or tumor necrosis factor inhibitors (TNFi) in rheumatoid arthritis patients. The composite primary outcome was the rate of major adverse cardiovascular outcomes (MACE, myocardial infarction (MI), peripheral artery disease (PAD) and cardiac heart failure (CHF)).
19 studies were included in the NMA, including 11 RCTs and 8 cohort studies. We found less events with RTX (5.41 [1.70;17.26]. We found no difference between TCZ and other treatments. Concerning MI, we found no difference between TCZ and csDMARD (4.23 [0.22;80.64]), no difference between TCZ and TNFi (2.00 [0.18;21.84]). There was no difference between TCZ and csDMARD (1.51[0.02;103.50] and between TCZ and TNFi (1.00 [0.06;15.85]) for stroke event. With cohorts and RCT NMA, we found no difference between TCZ and other treatments for MACE (0.66 [0.42;1.03] with ABA, 1.04 [0.60;1.81] with RTX, 0.78[0.53;1.16] and 0.91 [0.54;1.51] with csDMARD), but the risk of myocardial infarction was lower with TCZ compared to ABA (0.67 [0.47;0.97]). We lacked data to compare TCZ and other bDMARD for stoke and MI. Not enough data was available to perform a NMA for CHF and PAD.
Despite an increase in cholesterol levels, TCZ has safe cardiovascular outcomes compared to other bDMARD.
我们旨在通过网络荟萃分析（NMA）比较托珠单抗（TCZ）和其他生物改善病情抗风湿药（bDMARD）在类风湿关节炎中的心血管安全性。
通过系统文献检索，截至 2018 年 5 月，我们确定了报告托珠单抗（TCZ）和/或阿巴西普（ABA）和/或利妥昔单抗（RTX）和/或肿瘤坏死因子抑制剂（TNFi）治疗类风湿关节炎患者心血管结局的随机对照试验（RCT）或观察性研究（仅队列）。复合主要结局为主要不良心血管结局（MACE、心肌梗死（MI）、外周动脉疾病（PAD）和心力衰竭（HF））发生率。
NMA 纳入了 19 项研究，包括 11 项 RCT 和 8 项队列研究。我们发现 RTX 的事件发生率较低（5.41[1.70;17.26]）。我们未发现 TCZ 与其他治疗之间的差异。关于 MI，我们未发现 TCZ 与 csDMARD（4.23[0.22;80.64]）和 TCZ 与 TNFi（2.00[0.18;21.84]）之间的差异。TCZ 与 csDMARD（1.51[0.02;103.50]）和 TCZ 与 TNFi（1.00[0.06;15.85]）之间的卒中事件也无差异。在队列和 RCT 的 NMA 中，我们未发现 TCZ 与其他治疗之间在 MACE（与 ABA 为 0.66[0.42;1.03]，与 RTX 为 1.04[0.60;1.81]，与 csDMARD 为 0.78[0.53;1.16]和 0.91[0.54;1.51]）方面存在差异，但与 ABA 相比，TCZ 的心肌梗死风险较低（0.67[0.47;0.97]）。我们缺乏比较 TCZ 和其他 bDMARD 治疗卒中与 MI 的数据。有关心力衰竭和 PAD 的数据不足以进行 NMA。
尽管胆固醇水平升高，与其他 bDMARD 相比，TCZ 具有安全的心血管结局。
