Patients with Spondyloarthritis and obesity who fail TNF antagonist therapy: Change the subcutaneous injection site before the biologic? Comment on: “Impact of obesity on the efficacy of different biologic agents in inflammatory diseases: A systematic review and meta-analysis” by Shan et al. Joint Bone Spine, 2019, 86, 173-183

Abstract Aims Although alirocumab and evolocumab have both been associated with improved outcomes in patients with dyslipidaemia or established atherosclerotic cardiovascular disease, data on their respective performances are scarce. This study aimed at providing an indirect comparison of the efficacy and safety of alirocumab vs. evolocumab. Methods and results We conducted a systematic review and network meta-analysis of randomized trials comparing alirocumab or evolocumab to placebo with consistent background lipid-lowering therapy up to November 2018. We estimated the relative risk (RR) and the 95% confidence intervals (CIs) using fixed-effect model in a frequentist pairwise and network meta-analytic approach. A total of 30 trials, enrolling 59 026 patients were included. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab was associated with a significant reduction in all-cause death (RR 0.80, 95% CI 0.66–0.97) but not in cardiovascular death (RR 0.83, 95% CI 0.65–1.05). This study did not find any significant differences in myocardial infarction (RR 1.15, 95% CI 0.99–1.34), stroke (RR 0.96, 95% CI 0.71–1.28), or coronary revascularization (RR 1.13, 95% CI 0.99–1.29) between the two agents. Alirocumab was associated with a 27% increased risk of injection site reaction compared to evolocumab; however, no significant differences were found in terms of treatment discontinuations, systemic allergic reaction, neurocognitive events, ophthalmologic events, or new-onset of or worsening of pre-existing diabetes. Conclusion Alirocumab and evolocumab share a similar safety profile except for injection site reaction. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to the heterogeneity of the studied populations treated with the two drugs.

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Faculty Opinions recommendation of The immunogenicity of anti-TNF therapy in immune-mediated inflammatory diseases: a systematic review of the literature with a meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717969501.793470033 ◽

2013 ◽

Author(s):

Kamran Ghoreschi ◽

Amir S Yazdi

Keyword(s):

Systematic Review ◽

Inflammatory Diseases ◽

Meta Analysis ◽

Review Of The Literature ◽

Immune Mediated

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Association between eczema and major cardiovascular outcomes in population-based studies: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2017-017979 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017979 ◽

Cited By ~ 1

Author(s):

Anna Ascott ◽

Ashley M Yu ◽

Morten Schmidt ◽

Katrina Abuabara ◽

Liam Smeeth ◽

...

Keyword(s):

Systematic Review ◽

Inflammatory Diseases ◽

Data Extraction ◽

Meta Analysis ◽

Epidemiological Data ◽

Epidemiological Studies ◽

Cardiovascular Death ◽

Population Based ◽

Cardiovascular Outcomes ◽

Cross Sectional

IntroductionChronic inflammatory diseases such as eczema (also known as atopic dermatitis) have been inconsistently linked to cardiovascular disease and stroke in both mechanistic and epidemiological studies. There is a need to review the existing epidemiological data examining the association between eczema and major cardiovascular outcomes, including angina, myocardial infarction, coronary revascularisation, heart failure, cardiac arrhythmias, stroke and cardiovascular death, in order to improve our understanding of the comorbidities of eczema.Methods and analysisWe will systematically review population-based studies, including cohort, case–control and cross-sectional studies, reporting on the association between eczema and cardiovascular outcomes. We will search Medline, Embase and Global Health, from their date of inception to April 2017, using a comprehensive search strategy formulated with the help of a librarian. Two reviewers will independently screen titles and abstracts in duplicate, followed by independent data extraction and quality assessment. We will group studies by the cardiovascular outcome under study and synthesise them narratively. If sufficient numbers of homogeneous studies are returned, we will perform meta-analyses to obtain pooled effect estimates. Preferred Reporting Items for Systematic Review and Meta-Analysis will be used to inform the reporting of this study.Trial registration numberCRD42017060359.

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