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Anti-TNF Hypertension Connection Is Real, Meta-Analysis Shows

Numbers in randomized drug trials were too small to amass enough adverse events to settle the issue, but combined they show an increased hypertension risk for the tumor necrosis factor inhibitors used to treat rheumatoid arthritis.

Zhao Q, Hong D, Zhang Y, et al.  Association Between Anti-TNF Therapy for Rheumatoid Arthritis and Hypertension: A Meta-Analysis of Randomized Controlled TrialsMedicine. 94(14):e731. April 2015. doi: 10.1097/MD.0000000000000731

A meta-analysis of 11 randomized trials involving over 6,000 patients has confirmed that anti-tumor necrosis factor (TNF) agents used to treat rheumatoid arthritis (RA) do put patients at increased risk for hypertension.
While data on hypertension risks with anti-TNFs for RA are available, randomized trials “have been too brief or too small to accumulate enough hypertension events,” and findings are inconsistent, these authors report.

According to their analysis, the overall incidence of hypertension was 3.25% (confidence interval (CI) 1.5-6.9%). The use of anti-TNF agents increased the risk of hypertension nearly two-fold (odds ratio (OR) 1.9, CI 1.35-2.65). The risk increased with time, and doubled after 6 months of treatment.

However, the absolute risk and incidence are low, the authors say, and should be weighed against the overall survival and other benefits of anti-TNF treatment.

In the subgroup analysis, certolizumab had a significantly increased risk (OR 3.62, CI 1.5-8.7), which was previously identified in a Cochrane review, the authors note. Etanercept and tofacitinib turned in similar risk levels.

The authors conclude that their data add to the “findings that challenge the security profile” of an agent that has redefined RA treatment.