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Published on: October 27, 2023
Impact of Biologics on Cardiovascular Events in Ankylosing Spondylitis: A Meta-Analysis
Huijiao Yin1, Yingying Wang1, Zhongqin Chen1
1Rheumatology and Immunology Department, Changxing People's Hospital, Huzhou, Zhejiang, China.
Insights
Biologic therapy may lower cardiovascular event risk in ankylosing spondylitis (AS) patients, reducing myocardial infarction and ischemic heart disease. Further research is needed for specific drug effects and other event types.
Area of Science:
- Rheumatology
- Cardiology
- Pharmacology
Background:
- Ankylosing spondylitis (AS) is a chronic inflammatory disease.
- Cardiovascular events (CEs) are a concern in AS patients.
- The role of biologic therapies in mitigating CEs in AS is under investigation.
Purpose of the Study:
- To conduct a meta-analysis evaluating the impact of biologic therapies on the incidence of cardiovascular events (CEs) in patients diagnosed with ankylosing spondylitis (AS).
Main Methods:
- Comprehensive literature searches were conducted across major databases (Embase, Web of Science, PubMed, Cochrane Library) up to March 28, 2025.
- Quality assessment of included studies utilized the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool.
- Data analysis was performed using STATA 15.0.
Main Results:
- The meta-analysis included 23 studies with 92,623 participants.
- Biologic therapy was associated with a significantly lower overall risk of CEs (RR=0.61, p=0.003), including myocardial infarction (RR=0.42, p<0.001) and ischemic heart disease (RR=0.09, p<0.001).
- No significant differences in heart failure risk or CEs with etanercept, ixekizumab, or golimumab were observed.
Conclusions:
- Biologic use appears to reduce the risk of CEs, particularly ischemic heart disease and myocardial infarction, in AS patients.
- The findings suggest a potential cardiovascular benefit of biologics in AS management.
- Further large randomized controlled trials are warranted to investigate specific CE subtypes and individual biologic drug effects.
Objectives:
This meta-analysis aimed to explore the impact of biologics on the development of cardiovascular events (CEs) in patients with ankylosing spondylitis (AS).
Methods:
We collected literature related to the effects of biologics on CEs in AS patients through computerized searches of Embase, Web of Science, PubMed, and the Cochrane Library, as well as manual searches. The literature retrieval spanned from the inception of these databases up to March 28, 2025. Literature selection and data extraction were performed in accordance with predefined eligibility criteria. The Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool for randomized trials were utilized to evaluate the quality of eligible articles. Data analysis was performed using STATA 15.0.
Results:
This meta-analysis incorporated 23 eligible articles encompassing 92 623 subjects. The results illustrated that the biologics group had a lower overall CE risk than the non-biologics group (RR = 0.61, 95% CI, 0.44-0.84, p = 0.003). Specifically, the biologics group demonstrated a reduced risk of myocardial infarction (RR = 0.42, 95% CI, 0.27-0.65, p < 0.001) and ischemic heart disease (RR = 0.09, 95% CI, 0.04-0.17, p < 0.001). However, there were no significant differences in the risk of heart failure between the two groups (p > 0.05). There was no statistically significant variation in the occurrence of CEs between the two groups with the use of etanercept, ixekizumab, or golimumab (p > 0.05).
Conclusion And Relevance:
Overall, biologic use may mitigate the risk of CEs, particularly impacting IHD and MI. Given the limitations inherent in the current body of research, additional large randomized controlled trials examining other CE subtypes and specific drug effects are needed.
Trial Registration:
Not applicable.
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