The Impact of Biologic Therapy on Cardiovascular Risk in Rheumatoid Arthritis
DOI:
https://doi.org/10.32782/2415-8127.2026.74.19Keywords:
cardiology, rheumatology, tumour necrosis factor-alpha inhibitors, tocilizumab, rituximab, abatacept, Janus kinase inhibitorsAbstract
Patients with rheumatoid arthritis have a substantially higher cardiovascular risk than the general population, because chronic systemic inflammation accelerates atherogenesis independently of traditional risk factors. Despite the widespread use of biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis, data on the differential impact of specific classes of this therapy on cardiovascular outcomes remain fragmented, and the emergence of targeted synthetic Janus kinase inhibitors has further complicated the clinical picture with conflicting safety signals. The aim of the review was to summarise current scientific evidence on the impact of tumour necrosis factor-alpha inhibitors, interleukin-6 receptor inhibitors, rituximab and abatacept, as well as Janus kinase inhibitors as a comparator, on cardiovascular risk in rheumatoid arthritis. A systematised search was performed in PubMed/MEDLINE, Embase, Cochrane Library and Google Scholar (search completed on 14 July 2026); the analysis included randomised controlled trials, cohort studies based on real-world practice registries, systematic reviews and meta-analyses. The synthesis of available data indicates that tumour necrosis factor-alpha inhibitors, interleukin-6 receptor inhibitors, rituximab and abatacept are associated with a neutral or favourable cardiovascular safety profile, whereas for Janus kinase inhibitors a randomised trial revealed an increased risk of cardiovascular and thromboembolic events in at-risk patients, a finding only partially confirmed by more recent real-world registry data. Control of inflammatory activity with biologic therapy generally contributes to a reduction in cardiovascular risk, although this effect is heterogeneous and depends on the drug class and the patient’s baseline profile, which justifies individualised risk stratification in accordance with the updated EULAR recommendations (2025 update).
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