Cardiovascular safety of Janus kinase inhibitors in patients with rheumatoid arthritis: a meta-analysis

Abstract

Introduction: Janus kinase (JAK) inhibitors are a new class of medication approved for treating rheumatoid arthritis. As JAKs are involved in lipid metabolism, we investigated the cardiovascular safety of JAK inhibitors. Methods: Literature search was conducted using Medline, ISI Web of Science, Scopus, Embase and clinicaltrials.gov. Randomised controlled trials reporting major cardiovascular events or hypertension were included. Results were analysed using RevMan 5.3.5. Odds ratio (OR), mean difference, and 95% confidence interval (CI) were estimated using random-effects model. Results: A total of 23 studies were included in this meta-analysis. Janus kinase inhibitors were not associated with major cardiovascular events (OR=0.94, 95% CI=0.57-1.57). Tofacitinib was not associated with hypertension (OR=1.53, 95% CI=0.96-2.43). However, JAK inhibitors were associated with an increase in high-density lipoprotein (OR=10.11, 95% CI=8.03-12.19 mg/dL) and low-density lipoprotein cholesterol (OR=7.99, 95% CI=7.14-8.85 mg/dL), respectively. Conclusion: Although JAK inhibitors were not associated with increased major cardiovascular events, they were associated increased low-density lipoprotein and high-density lipoprotein. Tofacitinib was not associated with hypertension. Physicians should monitor the lipids of patients taking JAK inhibitors.