Major cardiovascular event risk of advanced therapies in inflammatory bowel diseases: systematic review and meta-analysis.

IF 6.2 3区医学 Q2 CELL BIOLOGY

Inflammation Research Pub Date : 2026-09-14 DOI:10.1007/s00011-026-02336-0

Amirah H Alnahdi, Chelsea Salmon, Fanxing Du, Mikael Svensson, Naueen Chaudhry, Ellen M Zimmermann, Tianze Jiao

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引用次数: 0

Abstract

Background: Patients with chronic immune-mediated disorders (IMIDs), including inflammatory bowel disease (IBD), are at increased risk of cardiovascular disease. While advanced therapies show cardioprotective effects in other IMIDs, their impact on major adverse cardiovascular events (MACE) in IBD remains unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating MACE risk with advanced therapies in IBD.

Methods: Systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials identified 43 studies (36 RCTs, including 9 long-term follow-up (LTF) studies, and 7 observational studies) published between 2002 and 2024. Primary analyses estimated odds ratios (OR) for MACE comparing advanced therapy to placebo, with secondary analyses stratifying studies by drug class and length of follow-up. Sensitivity analyses were conducted using alternative methods to account for zero-event data.

Results: Placebo-controlled RCTs showed a nonsignificant trend toward reduced MACE risk (OR 0.60; 95% CI 0.24-1.51), with similar findings across sensitivity analyses accounting for sparse and zero-event data. Class-specific trends suggested lower MACE risk with IL-12/IL-23 inhibitors (OR 0.35; 95% CI 0.05-2.21), JAK inhibitors (OR 0.57; 95% CI 0.16-2.06), and a potential increase with Anti-TNF agents (OR: 3.04; 95% CI 0.31-29.47), though none reached statistical significance. LTF studies showed consistent findings. Observational studies suggested lower MACE risk with Anti-TNF therapies (OR 0.29; 95% CI 0.21-0.40), but not with IL-12/IL-23 (OR 4.41; 95% CI 0.49-39.28) or JAK inhibitors (OR 1.57; 95% CI 0.86-2.84).

Conclusion: Advanced therapies did not demonstrate a clear increase or decrease in cardiovascular risk in IBD. The discrepancies between RCTs and observational studies underscore the urgent need for rigorous-designed observational research with long-term follow-up to evaluate the real-world impact of advanced therapies on MACE risk.

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炎性肠病先进治疗的主要心血管事件风险：系统回顾和荟萃分析

背景：慢性免疫介导性疾病（IMIDs）患者，包括炎症性肠病（IBD），发生心血管疾病的风险增加。虽然先进的治疗方法在其他IMIDs中显示出心脏保护作用，但它们对IBD主要不良心血管事件（MACE）的影响尚不清楚。我们对随机对照试验（rct）和观察性研究进行了荟萃分析，评估了IBD先进治疗的MACE风险。方法：系统检索PubMed、Embase和Cochrane中央对照试验登记册，确定了2002年至2024年间发表的43项研究（36项随机对照试验，包括9项长期随访（LTF）研究和7项观察性研究）。初步分析估计了先进治疗与安慰剂比较MACE的优势比（OR），二级分析根据药物类别和随访时间对研究进行了分层。敏感性分析采用替代方法来解释零事件数据。结果：安慰剂对照随机对照试验显示MACE风险降低的趋势不显著（OR 0.60; 95% CI 0.24-1.51），在考虑稀疏和零事件数据的敏感性分析中也有类似的发现。类别特异性趋势表明，IL-12/IL-23抑制剂（OR 0.35; 95% CI 0.05-2.21）、JAK抑制剂（OR 0.57; 95% CI 0.16-2.06）和抗tnf药物（OR: 3.04; 95% CI 0.31-29.47）的MACE风险较低，但均无统计学意义。LTF研究结果一致。观察性研究表明，抗肿瘤坏死因子治疗降低MACE风险（OR 0.29; 95% CI 0.21-0.40），但IL-12/IL-23 （OR 4.41; 95% CI 0.49-39.28）或JAK抑制剂（OR 1.57; 95% CI 0.86-2.84）没有降低MACE风险。结论：先进的治疗方法并没有显示出IBD患者心血管风险的明显增加或减少。随机对照试验和观察性研究之间的差异强调了迫切需要严格设计的观察性研究，并进行长期随访，以评估先进疗法对MACE风险的实际影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Inflammation Research 医学-免疫学

CiteScore

9.90

自引率

1.50%

发文量

134

审稿时长

3-8 weeks

期刊介绍： Inflammation Research (IR) publishes peer-reviewed papers on all aspects of inflammation and related fields including histopathology, immunological mechanisms, gene expression, mediators, experimental models, clinical investigations and the effect of drugs. Related fields are broadly defined and include for instance, allergy and asthma, shock, pain, joint damage, skin disease as well as clinical trials of relevant drugs.