Examining anti-inflammatory therapies in the prevention of cardiovascular events: protocol for a systematic review and network meta-analysis of randomised controlled trials

by Selleckchem | May 30 2023

Introduction: Inflammation is emerging as an important risk factor for atherosclerotic cardiovascular disease and has been a recent target for many novel therapeutic agents. However, comparative evidence regarding efficacy of these anti-inflammatory treatment options is currently lacking.

Methods and analysis: This systematic review will include randomised controlled trials evaluating the effect of anti-inflammatory agents on cardiovascular outcomes in patients with known cardiovascular disease. Studies will be retrieved from Medline, Embase, the Cochrane Central Register of Controlled Trials, as well as clinical trial registry websites, Europe PMC and conference abstract handsearching. No publication date or language restrictions will be imposed. Eligible interventions must have some component of anti-inflammatory agent. These include (but are not limited to): non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, prednisone, methotrexate, canakinumab, pexelizumab, anakinra, succinobucol, losmapimod, inclacumab, atreleuton, LP-PLA2 (darapladib) and sPLA2 (varespladib). The primary outcomes will include major adverse cardiac events (MACE), and each individual component of MACE (myocardial infarction, stroke and cardiovascular death). Key secondary outcomes will include unstable angina, heart failure, all-cause mortality, cardiac arrest and revascularisation. Screening, inclusion, data extraction and quality assessment will be performed independently by two reviewers. Network meta-analysis based on the random effects model will be conducted to compare treatment effects both directly and indirectly. The quality of the evidence will be assessed with appropriate tools including the Grading of Recommendations, Assessment, Development and Evaluation profiler or Confidence in Network Meta-Analysis tool.

Ethics and dissemination: Ethics approval is not required for this systematic review. The findings will be disseminated through a peer-reviewed journal.

Comments：

The proposed systematic review aims to evaluate the efficacy of anti-inflammatory agents in preventing cardiovascular outcomes in patients with known cardiovascular disease. The study will be conducted by retrieving data from various databases and clinical trial registry websites without any restrictions on publication date or language. The eligible interventions will include a range of anti-inflammatory agents, and the primary outcomes will include major adverse cardiac events and each individual component of MACE.

The study will be conducted following a comprehensive search strategy and the data will be independently reviewed and assessed by two reviewers. Network meta-analysis based on the random effects model will be used to compare treatment effects both directly and indirectly. The quality of the evidence will be assessed using appropriate tools such as the Grading of Recommendations, Assessment, Development, and Evaluation profiler or Confidence in Network Meta-Analysis tool.

The dissemination of the study's findings will be through a peer-reviewed journal. It is not necessary to obtain ethics approval for a systematic review.

Overall, the proposed methodology appears to be appropriate for addressing the research question. It is important to note that conducting a systematic review can be a time-consuming and challenging process, and it is important to ensure that the study's protocol is robust to minimize bias and increase the reliability of the results.