title: Cardiovascular outcomes and tumour necrosis factor antagonists in chronic inflammatory rheumatic disease: a focus on rheumatoid arthritis.
abstract: Many chronic rheumatic diseases have an inflammatory etiology, leading to accelerated atherosclerosis and increased occurrence of vascular diseases. In rheumatoid arthritis (RA), a reduction in cardiovascular (CV) events has been reported under treatments reducing systemic inflammation. Areas covered: Given the central role of tumour necrosis factor alpha (TNFα) in chronic inflammatory conditions and in atherosclerosis, it has been suggested that TNFα-antagonists may reduce CV risk and mortality. Although there are no randomized controlled or head-to-head trials investigating the effect of specific anti-TNF-agents on CV outcomes, observational cohort studies, national registry data, and meta-analyses in RA have reported improved CV outcomes with anti-TNF therapy. Expert opinion: It is unclear whether this is due to reduced systemic inflammation or a specific anti-TNF effect at the atherosclerotic plaque level. Observed CV benefits appear to correlate with anti-TNF response. Conversely, although inconsistently, anti-TNF agents have also been linked with increased incidence/worsening of heart failure. Additional CV adverse events with anti-TNFs include vasculitis and venous thromboembolic events. We provide an overview of the likely effects of anti-TNF therapy on CV risk and adverse events, and evaluated differences in CV outcomes among different anti-TNF-agents.
authors.affiliation: a Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology , University of Rome Sapienza , Sant'Andrea Hospital, Rome , Italy.|b IRCCS Neuromed , Pozzilli , Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.affiliation: c Translational Research Unit, Department of Epidemiology and Preclinical Research , National Institute for Infectious Diseases , Rome , Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: Goletti
authors.affiliation: d Medical Department , Pfizer Italy , Rome , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Marino
authors.affiliation: e Immunoallergology Unit , Department of Biomedicine, Azienda Ospedaliero-Universitaria Careggi , Florence , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Matucci
authors.affiliation: f Department of Pediatric Hematology, Oncology and Transplant Unit , IRCCS Ospedale Pediatrico Bambino Gesù , Rome , Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Milano
authors.affiliation: g Division of Rheumatology , Misericordia e Dolce Hospital , Prato , Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cantini
authors.affiliation: h Rheumatology Research Unit, Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scarpa
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006333:Heart Failure / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014657:Vasculitis / Q000139:chemically induced / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Anti-TNF agents; TNF-alpha; cardiovascular outcomes; chronic inflammation; rheumatic disease