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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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Sensitivity analysis of associated hypertension with anti-TNF agent versus controls.
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Figure 4: Sensitivity analysis of associated hypertension with anti-TNF agent versus controls.

Mentions: To investigate the specific contribution of anti-TNF antibody to the incidence of hypertension and exclude the influence of confounding factors, such as food, the disease itself, and the history of other therapeutic interventions, we determined the OR of hypertension between anti-TNF antibody and control groups. The pooled OR of hypertension demonstrated that anti-TNF antibody significantly increased the risk of hypertension comparing with control with an OR of 1.8896 (95% CI: 1.35–2.65; P value = 0.0002, Figure 3) according to a fixed-effects model (I2 = 0%, P = 0.5579).4,5,19–23,34–37 To validate the relative risk of hypertension between anti-TNF antibody and control groups, we also performed sensitivity analysis to examine the stability and reliability of pooled OR by sequential omission of individual studies. The results indicated that the significance estimate of pooled OR was not significantly influenced by omitting any single study (Figure 4).


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)

Sensitivity analysis of associated hypertension with anti-TNF agent versus controls.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Sensitivity analysis of associated hypertension with anti-TNF agent versus controls.
Mentions: To investigate the specific contribution of anti-TNF antibody to the incidence of hypertension and exclude the influence of confounding factors, such as food, the disease itself, and the history of other therapeutic interventions, we determined the OR of hypertension between anti-TNF antibody and control groups. The pooled OR of hypertension demonstrated that anti-TNF antibody significantly increased the risk of hypertension comparing with control with an OR of 1.8896 (95% CI: 1.35–2.65; P value = 0.0002, Figure 3) according to a fixed-effects model (I2 = 0%, P = 0.5579).4,5,19–23,34–37 To validate the relative risk of hypertension between anti-TNF antibody and control groups, we also performed sensitivity analysis to examine the stability and reliability of pooled OR by sequential omission of individual studies. The results indicated that the significance estimate of pooled OR was not significantly influenced by omitting any single study (Figure 4).

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