Risk of cardiovascular disease associated with use of tumor necrosis factor inhibitors in ankylosing spondylitis
- Author:
Ji-Won KIM
1
;
Jun Sik YOON
;
Sojeong PARK
;
Hasung KIM
;
Bo Young KIM
;
Hwajeong LEE
;
Sung-Hoon PARK
;
Seong-Kyu KIM
;
Jung-Yoon CHOE
Author Information
- Publication Type:Original Article
- From:Journal of Rheumatic Diseases 2026;33(1):46-54
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:To examine the risk of cardiovascular disease (CVD) associated with use of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).
Methods:This study used data from the Korean National Health Insurance database. Patients aged ≥18 years who were newly diagnosed with AS between 2010 and 2018 and did not suffer prior CVD were included. The primary outcome was a composite endpoint of myocardial infarction (MI) or stroke. The secondary outcomes were specific endpoints of MI, stroke, or congestive heart failure. TNFi use was evaluated as a time-dependent variable. Cox proportional hazard regression was used to examine the association between TNFi use and risk of incident CVD.
Results:Of 19,775 patients (mean age, 36.1 years; 75% male), 5,978 (30.2%) were exposed to TNFi treatment during the study period. During a follow-up of 4.8 (interquartile range, 2.9~7.2) years, 522 events of MI or stroke occurred. TNFi use was associated with a lower risk of MI or stroke than no TNFi use after adjusting for traditional CV risk factors and medications (adjusted hazard ratio [aHR], 0.72; 95% confidence interval [CI], 0.55~0.94). The lower risk of MI or stroke associated with TNFi use was consistently observed across subgroups. Risk of congestive heart failure did not differ between users and non-users of TNFi (aHR, 0.94; 95% CI, 0.75~1.18).
Conclusion:In a real-world AS cohort, TNFi treatment was associated with a reduced risk of atherosclerotic CVD. However, TNFi use was not associated with risk of congestive heart failure.
