Do anti‐tumour necrosis factor‐α biologics affect subclinical measures of atherosclerosis and arteriosclerosis? A systematic review

• Published in: British journal of clinical pharmacology Vol. 86; no. 5; pp. 837 - 851
• Main Authors: Knowles, Laurence, Nadeem, Nida, Chowienczyk, Philip J.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01-05-2020
• Subjects: atherosclerosiscardiovascular; inflammation; systematic review; Systematic Review and Meta‐analysis; systematic review; atherosclerosiscardiovascular; inflammation
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.14215

Aims: Inflammatory cytokines, particularly tumour necrosis factor‐α (TNFα), are thought to promote arterial disease through a variety of mechanisms leading to arteriosclerosis and atherosclerosis. We reviewed the existing evidence of the effect of anti‐TNFα treatment on arteriosclerosis and atherosclerosis in chronic inflammatory disease.
Methods: We performed a systematic review of studies examining effects of monoclonal antibodies against TNFα on subclinical measures of arteriosclerosis (arterial pulse wave velocity) and atherosclerosis (endothelial function measured by flow‐mediated dilation or forearm blood flow responses to endothelium‐dependent agonists, and common carotid intima‐media thickness).
Results: We identified 60 studies (of 854 potential studies identified using a systematic search) in which effects of anti‐TNFα biologics on these measures were assessed in patients receiving anti‐TNFα therapy for a clinical indication (usually an inflammatory disease such as an inflammatory arthritis, psoriasis or inflammatory bowel disease). Of these, only 6 were randomised clinical controlled trials. Whilst many observational studies and noncontrolled studies reported positive findings, positive finding were reported in only 1 of 6 randomised clinical controlled trials.
Conclusions: There is no strong evidence for an effect of anti‐TNFα biologics on the subclinical measures of arteriosclerosis or atherosclerosis examined in this review. This does not exclude a positive effect of TNFα biologics on clinical outcomes through alternate pathways including those induced by remission of the primary inflammatory disease.