肿瘤坏死因子α抑制剂与类风湿关节炎的心血管风险

IF 8.4 2区 医学 Q1 ALLERGY
Nicoletta Luciano, Elisa Barone, Suraj Timilsina, M. Eric Gershwin, Carlo Selmi
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引用次数: 0

摘要

类风湿性关节炎(RA)是一种慢性炎症性疾病,由于传统风险因素和疾病相关风险因素之间复杂的相互作用,导致心血管事件风险增加。慢性炎症和持续的疾病活动是造成这种风险的主要决定因素,尽管在疾病管理和预后方面有了很大改善,但心血管事件仍是类风湿关节炎患者发病和死亡的主要原因1。在过去几十年中,随着新型生物和靶向合成 DMARDs 的出现,疾病活动控制也得到了改善,但每一类药物对心血管疾病风险的作用仍存在争议。自肿瘤坏死因子α(TNFα)抑制剂被批准用于治疗RA以来,人们对其进行了广泛的研究,以更好地了解它们对心血管预后的影响。最近,TNFα抑制剂和JAK抑制剂在合并心血管疾病危险因素的RA患者中的直接比较结果推翻了通过任何治疗减少慢性炎症可降低心血管风险的假设。本文献综述旨在补充现有证据,分析TNFα抑制剂与RA患者心血管疾病风险之间的关系,并提供一些临床场景,以更好地解释治疗难题。特别是,尽管有关主要心血管事件和血栓栓塞的数据似乎与TNFα抑制剂通过炎症介导的益处相一致,但人们仍对慢性心力衰竭患者使用该类bDMARDs表示担忧。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Tumor Necrosis Factor Alpha Inhibitors and Cardiovascular Risk in Rheumatoid Arthritis

Tumor Necrosis Factor Alpha Inhibitors and Cardiovascular Risk in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by an increased risk of cardiovascular events, due to the complex interplay between traditional and disease-related risk factors. Chronic inflammation and persistent disease activity are the key determinants of this risk, but despite great improvement in the disease management and prognosis, cardiovascular events are still the main cause of morbidity and mortality in RA cohorts1. In the last decades, the advent of new biological and targeted-synthetic DMARDs was accompanied by an improvement in disease activity control, but the role of each class of drugs on CVD risk is still a matter a debate. Since their approval for RA treatment, tumor necrosis factor alpha (TNFα) inhibitors have been widely investigated to better understand their effects on cardiovascular outcomes. The hypothesis that the reduction of chronic inflammation with any treatment may reduce the cardiovascular risk has been recently confuted by the direct comparison of TNFα-inhibitors and JAK inhibitors in patients with RA and coexisting risk factors for cardiovascular disease. The aim of this literature review is to add to the available evidence to analyze the relationship between TNFα-inhibitors and CVD risk in patients with RA and also provide some clinical scenarios to better explain the treatment dilemmas. In particular, while data on major cardiovascular events and thromboembolism seem consistent with an inflammation-mediated benefit with TNFα-inhibitors, there remain concerns about the use of this class of bDMARDs in patients with chronic heart failure.

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来源期刊
CiteScore
22.30
自引率
1.10%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Clinical Reviews in Allergy & Immunology is a scholarly journal that focuses on the advancement of clinical management in allergic and immunologic diseases. The journal publishes both scholarly reviews and experimental papers that address the current state of managing these diseases, placing new data into perspective. Each issue of the journal is dedicated to a specific theme of critical importance to allergists and immunologists, aiming to provide a comprehensive understanding of the subject matter for a wide readership. The journal is particularly helpful in explaining how novel data impacts clinical management, along with advancements such as standardized protocols for allergy skin testing and challenge procedures, as well as improved understanding of cell biology. Ultimately, the journal aims to contribute to the improvement of care and management for patients with immune-mediated diseases.
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