Kwon Oh Chan, Lee Hye Sun, Yang Juyeon, Park Min-Chan
Division of Rheumatology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-Gu, Seoul, 06273, South Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.
Clin Rheumatol. 2025 Jan;44(1):257-266. doi: 10.1007/s10067-024-07225-7. Epub 2024 Nov 7.
Patients with ankylosing spondylitis (AS) have a higher risk of cardiovascular events than controls. Although biological disease-modifying anti-rheumatic drugs (bDMARDs) are efficacious in treating AS, their effect on cardiovascular risk remains unclear. This study evaluated the effect of tumour necrosis factor inhibitors (TNFis) and interleukin-17 inhibitors (IL-17is) on cardiovascular risk in patients with AS.
Data of 43,502 patients diagnosed with AS from 2010 onwards and without prior history of cardiovascular events were extracted from the Korean nationwide database. Cardiovascular events were defined as incident myocardial infarctions or strokes. Patients were followed-up through 2021. The risk of cardiovascular events was compared between TNFis exposure (vs. bDMARDs non-exposure), IL-17is exposure (vs. bDMARDs non-exposure), and IL-17is exposure (vs. TNFis exposure), using time-dependent Cox models.
The incidence rates of cardiovascular events during bDMARDs non-exposure, TNFis exposure, and IL-17is exposure were 18.66, 8.92, and 12.87 per 10,000 person-years, respectively. TNFis exposure (vs. bDMARDs non-exposure) was significantly associated with a lower risk of cardiovascular events (adjusted hazard ratio [aHR] = 0.697, 95% confidence interval [CI] = 0.499-0.973), whereas IL-17is exposure (vs. bDMARDs non-exposure) was not (aHR = 0.962, 95% CI = 0.134-6.920). The risk of cardiovascular events did not differ between IL-17is and TNFis exposures (aHR = 1.381, 95% CI = 0.189-10.087).
TNFis exposure (vs. bDMARDs non-exposure) was associated with approximately 30% lower risk of cardiovascular events in patients with AS. IL-17is exposure had no significant association with the risk of cardiovascular events compared with bDMARDs non-exposure or TNFis exposure. Key Points • TNFis exposure was associated with a 30% lower cardiovascular risk in patients with AS. • IL-17is exposure had no significant association with cardiovascular risk in patients with AS. • TNFis could be the preferred bDMARD with regard to cardiovascular risk in patients with AS.
强直性脊柱炎（AS）患者发生心血管事件的风险高于对照组。尽管生物改善病情抗风湿药物（bDMARDs）在治疗AS方面有效，但其对心血管风险的影响仍不明确。本研究评估了肿瘤坏死因子抑制剂（TNFis）和白细胞介素-17抑制剂（IL-17is）对AS患者心血管风险的影响。
从韩国全国数据库中提取2010年起诊断为AS且无心血管事件既往史的43502例患者的数据。心血管事件定义为新发心肌梗死或中风。对患者随访至2021年。使用时间依赖性Cox模型比较TNFis暴露组（与未暴露于bDMARDs组相比）、IL-17is暴露组（与未暴露于bDMARDs组相比）以及IL-17is暴露组（与TNFis暴露组相比）发生心血管事件的风险。
未暴露于bDMARDs、暴露于TNFis和暴露于IL-17is期间心血管事件的发生率分别为每10000人年18.66、8.92和12.87例。暴露于TNFis（与未暴露于bDMARDs相比）与较低的心血管事件风险显著相关（校正风险比[aHR]=0.697，95%置信区间[CI]=0.499-0.973），而暴露于IL-17is（与未暴露于bDMARDs相比）则不然（aHR=0.962，95%CI=0.134-6.920）。暴露于IL-17is和TNFis的心血管事件风险无差异（aHR=1.381，95%CI=0.189-10.087）。
暴露于TNFis（与未暴露于bDMARDs相比）与AS患者心血管事件风险降低约30%相关。与未暴露于bDMARDs或暴露于TNFis相比，暴露于IL-17is与心血管事件风险无显著关联。要点•暴露于TNFis与AS患者心血管风险降低30%相关。•暴露于IL-17is与AS患者心血管风险无显著关联。•就心血管风险而言，TNFis可能是AS患者首选的bDMARD。
