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Association between anti-TNF therapy for rheumatoid arthritis and hypertension: a meta-analysis of randomized controlled trials.

Zhao Q, Hong D, Zhang Y, Sang Y, Yang Z, Zhang X - Medicine (Baltimore) (2015)

Bottom Line: No evidence of publication bias was observed.Anti-TNF therapy is associated with a significantly increased risk of developing hypertension in patients with RA.Physicians should be aware of this risk and provide continuing monitoring in patients receiving these therapies.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Pharmacy (QZ, DH, YZ, YS, ZY, XZ), the First Affiliated Hospital of College of Medicine, Zhejiang University; and College of Pharmaceutical Science (XZ), Zhejiang Chinese Medical University, Hangzhou, P.R. China.

ABSTRACT
Tumor necrosis factor (TNF) is an important and pleiotropic cytokine which is also involved in the pathogenesis of inflammation in rheumatoid arthritis (RA), and RA treated with anti-TNF agents with a subsequent increase in hypertension risk is also observed in clinical trials. However, it is confusing that to what extent treatment with anti-TNF agents for RA might be associated with increasing risk of hypertension. The aim of this study was to investigate the overall incidence and risk of hypertension in RA patients who receive anti-TNF agents. The databases of Embase, PubMed, the Cochrane Library, and clinical trial registration Web site were searched for relevant trials. Statistical analyses were conducted to calculate the overall incidence, odds ratios, and 95% confidence intervals (CI) by using either random-effects or fixed-effect models according to the heterogeneity of the included studies. A total of 6321 subjects with RA from 11 randomized clinical trials (RCTs) were included in the meta-analysis. The overall incidence of hypertension associated with anti-TNF agent was 3.25% (95% CI: 1.51%-6.89%). The use of anti-TNF agent significantly increased the risk of developing hypertension (OR = 1.8896, 95% CI: 1.35-2.65). Sensitivity analysis showed that the OR between anti-TNF therapy and controls is not significantly influenced by omitting any single study. No evidence of publication bias was observed. Anti-TNF therapy is associated with a significantly increased risk of developing hypertension in patients with RA. Physicians should be aware of this risk and provide continuing monitoring in patients receiving these therapies.

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Forest plot for meta-analysis of incidence of hypertension in patients with rheumatoid arthritis.
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Figure 2: Forest plot for meta-analysis of incidence of hypertension in patients with rheumatoid arthritis.

Mentions: A total of 1846 patients who were treated with anti-TNF agent monotherapy were available for analysis.5,19–21,23,34,36 There were 71 total hypertension events among these patients. The incidence of hypertension ranged from 0% to 13%, and the highest incidence occurred in the trials of patients treated with etanercept during a 2-year period.23 Based on data from included trials, the overall incidence of hypertension was 3.25% (95% CI: 1.51%–6.89%; Figure 2) according to the random-effects model (P < 0.001; I2 = 90%).


Association between anti-TNF therapy for rheumatoid arthritis and hypertension: a meta-analysis of randomized controlled trials.

Zhao Q, Hong D, Zhang Y, Sang Y, Yang Z, Zhang X - Medicine (Baltimore) (2015)

Forest plot for meta-analysis of incidence of hypertension in patients with rheumatoid arthritis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554042&req=5

Figure 2: Forest plot for meta-analysis of incidence of hypertension in patients with rheumatoid arthritis.
Mentions: A total of 1846 patients who were treated with anti-TNF agent monotherapy were available for analysis.5,19–21,23,34,36 There were 71 total hypertension events among these patients. The incidence of hypertension ranged from 0% to 13%, and the highest incidence occurred in the trials of patients treated with etanercept during a 2-year period.23 Based on data from included trials, the overall incidence of hypertension was 3.25% (95% CI: 1.51%–6.89%; Figure 2) according to the random-effects model (P < 0.001; I2 = 90%).

Bottom Line: No evidence of publication bias was observed.Anti-TNF therapy is associated with a significantly increased risk of developing hypertension in patients with RA.Physicians should be aware of this risk and provide continuing monitoring in patients receiving these therapies.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Pharmacy (QZ, DH, YZ, YS, ZY, XZ), the First Affiliated Hospital of College of Medicine, Zhejiang University; and College of Pharmaceutical Science (XZ), Zhejiang Chinese Medical University, Hangzhou, P.R. China.

ABSTRACT
Tumor necrosis factor (TNF) is an important and pleiotropic cytokine which is also involved in the pathogenesis of inflammation in rheumatoid arthritis (RA), and RA treated with anti-TNF agents with a subsequent increase in hypertension risk is also observed in clinical trials. However, it is confusing that to what extent treatment with anti-TNF agents for RA might be associated with increasing risk of hypertension. The aim of this study was to investigate the overall incidence and risk of hypertension in RA patients who receive anti-TNF agents. The databases of Embase, PubMed, the Cochrane Library, and clinical trial registration Web site were searched for relevant trials. Statistical analyses were conducted to calculate the overall incidence, odds ratios, and 95% confidence intervals (CI) by using either random-effects or fixed-effect models according to the heterogeneity of the included studies. A total of 6321 subjects with RA from 11 randomized clinical trials (RCTs) were included in the meta-analysis. The overall incidence of hypertension associated with anti-TNF agent was 3.25% (95% CI: 1.51%-6.89%). The use of anti-TNF agent significantly increased the risk of developing hypertension (OR = 1.8896, 95% CI: 1.35-2.65). Sensitivity analysis showed that the OR between anti-TNF therapy and controls is not significantly influenced by omitting any single study. No evidence of publication bias was observed. Anti-TNF therapy is associated with a significantly increased risk of developing hypertension in patients with RA. Physicians should be aware of this risk and provide continuing monitoring in patients receiving these therapies.

Show MeSH
Related in: MedlinePlus