Background: Anti-inflammatory therapies have been increasingly investigated for the reduction of cardiovascular (CV) events. The objective of this paper was to summarize and compare the relative effectiveness of anti-inflammatory medications for the reduction of CV events in patients with known coronary artery disease (CAD), either acute coronary syndromes (ACS) or stable CAD.

Methods: Systematic review and network meta-analysis of randomised controlled trials (RCTs) that included at least one anti-inflammatory treatment and involved patients with CAD. Databases searched: Medline, Embase, Cochrane Central Register of Controlled Trials, clinical trial registry websites, Europe PMC, and conference abstracts. Bayesian network meta-analysis was performed to calculate risk estimates using fixed-effects analyses in patients with ACS and stable CAD. Risk of bias assessments were performed using the Cochrane Risk of Bias 2 (RoB2) tool.

Results: 17,021 studies were screened; 41 met inclusion criteria. 29,487 patients were included in the ACS network and 41,791 in the stable CAD network. In the ACS network analysis, both non-steroidal anti-inflammatory drugs [OR: 0.30, 95% Credible Limits (CrI): 0.11-0.74] and colchicine (OR: 0.77, CrI: 0.62-0.95) were associated with a significant reduction in major adverse cardiac events (MACE) compared to control. In the stable CAD analysis, both corticosteroids (OR: 0.44, 95% CrI: 0.26-0.72) and colchicine (OR: 0.65, CrI: 0.54-0.77) were associated with a significant reduction in MACE compared to control.

Conclusions: In patients with ACS, colchicine was associated with a reduction in MACE, while observed associations for NSAIDs were derived from sparse and predominantly indirect evidence. In patients with stable CAD, colchicine and corticosteroids were associated with a reduction in MACE, although these findings were informed largely by indirect comparisons.

Systematic review registration: Identifier CRD42022303289.