Introduction and Hypothesis. The role of inflammation is widely recognized in the pathogenesis of coronary artery disease. Research on animal models had shown the potential benefits of targeting specific inflammatory pathways. However, studies on human subjects are limited with small number of patients and no head-to-head comparisons. Methods. We conducted a network meta-analysis of randomized controlled trials that studied the effects of anti-inflammatory medications on cardiovascular outcomes of coronary artery disease patients. We searched the electronic database until March 2020 for relevant studies. Results. Nineteen trials examining the efficacy of eight anti-inflammatory medications (pexelizumab, anakinra, colchicine, darapladib, varespladib, canakinumab, inclacumab, and losmapimod) were selected for analysis. Overall, there is no statistically significant difference in all-cause mortality, cardiovascular mortality, revascularization, and major cardio and cerebrovascular events (MACCE) with the use of anti-inflammatory drugs. However, we found the use of colchicine significantly reduces the odds of developing stroke by approximately 75% (OR 0.26, CI 0.10-0.63). Colchicine use was also associated with a lower risk of revascularization and MACCE compared to the other agents. Our subgroup analyses comparing the timing of medication initiation (within 7 days vs. >7 days) and clinical presentation (ACS vs. non-ACS) revealed a significant reduction in the risk of recurrent MI in the group that received medication after seven days (OR 0.92, CI 0.86-0.99) and the non-ACS group (OR 0.88, CI 0.80-0.98). Conclusion. Although many anti-inflammatory medications have failed to reduce adverse cardiovascular outcomes in the CAD population, selected medications show promise among subgroups of patients without ACS or after the first week following an acute ischemic event. Future studies examining the proper timing and targetable anti-inflammatory pathways are warranted.

中文翻译：

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冠心病患者抗炎药物治疗效果的比较：系统评价和网络荟萃分析

介绍和假设。炎症的作用在冠状动脉疾病的发病机制中得到广泛认可。动物模型研究显示了靶向特定炎症通路的潜在益处。然而，对人类受试者的研究仅限于少数患者且没有头对头比较。方法。我们对研究抗炎药物对冠状动脉疾病患者心血管结局影响的随机对照试验进行了网络荟萃分析。我们在电子数据库中搜索了直到 2020 年 3 月的相关研究。结果. 选择了 19 项检验八种抗炎药物（pexelizumab、anakinra、秋水仙碱、darapladib、varespladib、canakinumab、inclacumab 和 losmapimod）疗效的试验进行分析。总体而言，使用抗炎药在全因死亡率、心血管死亡率、血运重建和主要心脑血管事件（MACCE）方面没有统计学上的显着差异。然而，我们发现使用秋水仙碱可将发生中风的几率显着降低约 75%（OR 0.26，CI 0.10-0.63）。与其他药物相比，使用秋水仙碱还与较低的血运重建和 MACCE 风险相关。我们的亚组分析比较了药物开始时间（7 天内 vs. > 7 天内）和临床表现（ACS vs.结论。尽管许多抗炎药物未能减少 CAD 人群的不良心血管结局，但选定的药物在没有 ACS 或急性缺血事件后第一周后的患者亚组中显示出前景。未来的研究检查适当的时机和可靶向的抗炎途径是有必要的。