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Vascular effects of biologic and targeted synthetic antirheumatic drugs approved for rheumatoid arthritis: a systematic review

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Abstract

Background

Rheumatoid arthritis (RA) increases the risk of cardiovascular disease (CVD), with inflammation playing a key role. Biologic and targeted synthetic drugs used to treat RA can induce systemic immunomodulation and may have pleiotropic effects on vascular function, making it crucial to investigate their impact on CVD risk in RA patients.

Methods

A systematic review of the literature was conducted to investigate the impact of biologic and targeted synthetic treatments approved for RA on various cardiovascular markers, including endothelial function, arterial stiffness, and subclinical atherosclerosis. Our analysis included a search of the MedLine (via PubMed) and Web of Science databases using a pre-determined search strategy. We conducted a narrative synthesis of the included studies due to heterogeneity in study design and outcome measures.

Results

From an initial pool of 647 records, we excluded 327 studies based on their titles and abstracts, and we selected 182 studies for final examination. Ultimately, 58 articles met our inclusion criteria and were included in our systematic review. Our analysis of these studies revealed a positive effect of biologic and targeted synthetic therapies on vascular dysfunction associated with RA. However, the impact of these treatments on subclinical atherosclerosis was inconsistent.

Conclusion

Overall, our systematic review provides important insights into the potential cardiovascular benefits of biologic and targeted synthetic treatments for RA by a still unknown mechanism. These findings can inform clinical practice and contribute to our understanding of their possible effects on early vascular pathology.

Key Points

• Great heterogeneity of methods are used to evaluate the endothelial function and arterial stiffness in patients with RA on biologic and targeted synthetic antirheumatic drugs.

• Most studies have shown a considerable improvement in endothelial function and arterial stiffness with TNFi, despite some studies reporting only transient or no improvement.

• Anakinra and tocilizumab may have a beneficial effect on vascular function and endothelial injury, as indicated by increased FMD, coronary flow reserve, and reduced levels of biomarkers of endothelial function, while the overall impact of JAKi and rituximab remains inconclusive based on the reviewed studies.

• To fully comprehend the distinctions between biologic therapies, more long-term, well-designed clinical trials are necessary using a homogeneous methodology.

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Authors and Affiliations

  1. Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University – Varna, 9002, Varna, Bulgaria

    Georgi Gerganov & Maria Dimova

  2. Clinic of Rheumatology, University Hospital St. Marina – Varna, 9010, Varna, Bulgaria

    Georgi Gerganov, Tsvetoslav Georgiev & Tanya Shivacheva

  3. First Department of Internal Medicine, Faculty of Medicine, Medical University – Varna, 9002, Varna, Bulgaria

    Tsvetoslav Georgiev & Tanya Shivacheva

  4. Clinic of Internal Medicine, University Hospital St. Marina – Varna, 9010, Varna, Bulgaria

    Maria Dimova

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  1. Georgi Gerganov
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  4. Tanya Shivacheva
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All authors of this manuscript have made significant contributions to the conception and design of the study, the acquisition and analysis of data, and the interpretation of results. They have all participated in the drafting and critical revision of the manuscript, and have given their final approval for submission to this journal. Additionally, all authors agree to be responsible for all aspects of the work and are willing to be held accountable for any issues that may arise. Finally, all contributing authors have reviewed and approved the final version of the manuscript.

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Gerganov, G., Georgiev, T., Dimova, M. et al. Vascular effects of biologic and targeted synthetic antirheumatic drugs approved for rheumatoid arthritis: a systematic review. Clin Rheumatol 42, 2651–2676 (2023). https://doi.org/10.1007/s10067-023-06587-8

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