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Upadacitinib and Cardiovascular Adverse Events in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Fatemeh Omidi1, Parisa Delkash2, Mohammad Javad Nasiri3

  • 1Department of Cardiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Current Rheumatology Reviews
|November 8, 2024
PubMed

Insights

Upadacitinib (a JAK inhibitor) may increase cardiovascular risk, particularly at higher doses. However, current evidence lacks statistical significance, requiring cautious interpretation and further research for rheumatoid arthritis patients.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Cardiovascular Medicine

Background:

  • Upadacitinib, a Janus kinase (JAK) inhibitor, is used for rheumatoid arthritis.
  • Safety concerns exist regarding potential cardiovascular adverse events associated with upadacitinib.
  • Existing evidence is inconclusive regarding the definitive cardiovascular risk of upadacitinib.

Purpose of the Study:

  • To systematically review and meta-analyze the cardiovascular risk associated with upadacitinib.
  • To assess the pooled odds ratios (OR) and confidence intervals (CI) for cardiovascular events.
  • To evaluate potential publication bias in the existing literature.

Main Methods:

  • Systematic literature review up to March 15, 2024, using PubMed/Medline, Embase, and Cochrane CENTRAL.
  • Meta-analysis to calculate pooled OR and 95% CI for cardiovascular risks.
  • Publication bias assessment using Begg's and Egger's tests.

Main Results:

  • Six studies with 4,202 participants were included.
  • Upadacitinib 15 mg showed a non-significant OR of 1.20 (95% CI: 0.3-4.3) for cardiovascular events.
  • Upadacitinib 30 mg showed a higher, non-significant OR of 2.37 (95% CI: 0.6-9.1).
  • Begg's and Egger's tests confirmed the absence of publication bias.

Conclusions:

  • A potential increased cardiovascular risk with upadacitinib, especially at the 30 mg dose, is suggested.
  • The lack of statistical significance and wide CIs warrant a prudent approach.
  • Tailored treatment, monitoring, and further studies are essential for upadacitinib safety.
Abstract

Keywords:
Janus kinase inhibitorUpadacitinibcardiovascular adverse eventsmeta-analysispublication bias.rheumatoid arthritis

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