Article Text

SAT0099 Effect of TNF Inhibitors on Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis: A Meta-Analysis
  1. T.T. Cheung,
  2. M.F. Tsoi,
  3. B.M.Y. Cheung
  1. Medicine, The University of Hong Kong, Hong Kong, Hong Kong


Background Use of TNF inhibitors has been associated with a decrease in the incidence of cardiovascular events in patients with rheumatoid arthritis. However, studies investigating the effect of anti-TNF on subclinical atherosclerosis yielded contradictory results.

Objectives This meta-analysis aims to assess the effects of anti-TNF therapy on several markers of subclinical atherosclerosis in patients with rheumatoid arthritis.

Methods Articles published up to Jun 2014 were searched via PubMed, EMBase and Cochrane libary. Data from abstracts were searched from the databases of the American College of Rheumatology and European League against Rheumatism. In addition, the reference lists of the articles initially identified were manually searched to include additional relevant articles. 2 independent physicians analyzed each article.

Study had to be designed for studying the effects of TNF inhibitor on subclinical atherosclerosis and contain values of at least 1 variable among intima media thickness, pulse wave velocity or augmentation index before and after treatment. Observational studies, case control studies and randomized controlled trials were eligible. The data were analyzed according to the effects at 24 and 52 weeks.

Statistical analysis of pre-post data was performed by COMPREHENSIVE META-ANALYSIS, BIOSTAT. Analysis of standardized mean difference was carried out using a random effects model. The percentage heterogeneity in the study results beyond chance was determined by the I2 statistic. Publication bias was assessed by the Egger test and represented graphically by funnel plots.

Results Overall, 24-week TNF-α inhibitor treatment was not associated with statistical significant improvement in carotid intimal media thickness (SMD 0.28 95%CI 0.08 to 0.48) [fig. 1], pulse wave velocity (SMD -0.12 95%CI -0.55 to 0.32) [fig. 3] and arterial stiffness (SMD -0.05 95%CI -0.49 to 0.38) [fig. 4]. Based on available data, there was no significant difference in the effect of 52-week TNF-α inhibitor treatment on carotid intimal media thickness (SMD -0.07 95%CI -0.54 to 0.41) [fig. 2].

Significant heterogeneity was found in studies evaluating the effect of 52-week TNF inhibitor treatment on carotid intimal media thickness (I2=74%, P=0.010). Omission of Del's study results in significant SMD (SMD 0.24 95%CI 0.03 to 0.45) and I2 was reduced to 0%.

Funnel plots of standard error of SMD against SMD did not show any significant bias.

Conclusions Short term use of TNF inhibitors was not associated with improvement in subclinical atherosclerosis, as measured by carotid intima thickness, pulse wave velocity and augmentation index


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  2. Daien, C.I., et al., Etanercept normalises left ventricular mass in patients with rheumatoid arthritis. Ann Rheum Dis, 2013. 72(6): p. 881-7.

  3. Tam, L.S., et al., Infliximab is associated with improvement in arterial stiffness in patients with early rheumatoid arthritis – a randomized trial. J Rheumatol, 2012. 39(12): p. 2267-75.

  4. Del Porto, F., et al., Response to anti-tumour necrosis factor alpha blockade is associated with reduction of carotid intima-media thickness in patients with active rheumatoid arthritis. Rheumatology (Oxford), 2007. 46(7): p. 1111-5.

Disclosure of Interest None declared

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