PhD Defence: Noémi Ágnes Galajda (TNF Inhibitors and Cardiovascular Risk in IMIDs)

The Effects of Tumour Necrosis Factor Inhibitors on Cardiovascular Risk In Immune-Mediated Inflammatory Diseases

Patients with immune-mediated inflammatory diseases (IMIDs)—such as psoriasis, rheumatoid arthritis, and inflammatory bowel disease—carry a significantly increased risk of cardiovascular morbidity and mortality. Chronic systemic inflammation, driven in part by tumour necrosis factor (TNF), plays a central role in both disease activity and atherosclerosis.

In this PhD defence, Noémi Ágnes Galajda, MD, PhD candidate at the Department of Dermatology, Semmelweis University and the Centre for Translational Medicine, presents two comprehensive meta-analyses examining the cardiovascular effects of TNF inhibitor therapy in IMID populations.

1) Atherosclerotic cardiovascular events
The first project evaluates whether TNF inhibitors reduce the risk of major adverse cardiovascular events compared with conventional systemic treatments (such as methotrexate).
Across multiple IMID populations, TNF inhibitor therapy was associated with a clinically and statistically significant reduction in myocardial infarction and cerebrovascular events, with particularly strong evidence in psoriasis and rheumatoid arthritis.

2) Heart failure risk and safety
The second project addresses a long-standing safety concern surrounding TNF inhibitors: their potential association with heart failure.
Using randomized and real-world data, this meta-analysis demonstrates no increased risk of new-onset heart failure and no significant worsening of existing heart failure associated with TNF inhibitor use—findings that challenge historical contraindications and may inform future guideline updates.

Together, these results suggest that TNF inhibitors may offer cardiovascular benefit without increasing heart failure risk, supporting a more individualized, comorbidity-aware approach to treatment selection in IMIDs.

This work highlights the importance of integrating cardiovascular risk into therapeutic decision-making and demonstrates how translational evidence can directly influence clinical guidelines and long-term patient outcomes.