Effects of tumor necrosis factor blockade on cardiovascular risk factors in psoriatic arthritis: A double‐blind, placebo‐controlled study

Abstract

Objective. To conduct a robust, double-blind, placebo-controlled study examining the effects of tumor necrosis factor (TNF) modulation on concentrations of traditional and novel cardiovascular disease risk factors in patients with an inflammatory condition.Methods. In this double-blind study, 127 patients with psoriatic arthritis (PsA) and active psoriasis were randomized to 1 of 3 treatment arms (placebo, onercept 50 mg, or onercept 100 mg for 12 weeks). Traditional and novel biochemical risk factors were evaluated at baseline and at the end of the treatment period.Results. At baseline, an elevated C-reactive protein ( Conclusion. This study is the first to demonstrate that targeting the TNF pathway can significantly decrease Lp(a) and homocysteine levels and elevate Apo A-I and SHBG concentrations. These data support an important precursor role for high-grade inflammation in modulating these putative risk parameters. However, TNF blockade-induced increases in triglyceride and Apo B levels were unexpected and suggest that it is not possible, on the basis of biochemical changes in isolation, to suggest that cardioprotection would necessarily follow; rather, direct measures of atherosclerotic progression with TNF blockade (e.g., using carotid ultrasound) would be better.

Cardiovascular Morbidity in Psoriatic Arthritis: What Is the Effect of Inflammation?

“…The reduction in ApoB/ApoAI ratio, which has been associated with a favorable CV outcome in the general population in the setting of a general increase in lipids levels, highlights the complexity of interpreting changes in conventional lipid profile in the context of active inflammation and antiinflammatory therapy. In line with this finding, others have reported potentially favorable changes in lipid particles, such as a reduction in Lp(a) and an increase in ApoAI, following TNF-α inhibitors in patients with PsA 18 . A similar phenomenon was observed in RA with other biologic therapies including IL-6 inhibitors and Janus kinase inhibitors 19,20 .…”

Efficacy and Rapid Response of Tocilizumab in Rheumatoid Arthritis Patients not Responder to Previous Biologic Therapy

“…Therefore, changes in lipid profiles, particularly the elevation in cholesterol and triglycerides levels that occur with treatments for severe inflammation, may not represent increased cardiovascular risk as in the usual understanding of lipid-level elevations in individuals without significant inflammation [33][34][35]. Rather, such changes in lipid levels, in part or largely, may represent a predictable response to attenuation of inflammation.…”

“…Rather, such changes in lipid levels, in part or largely, may represent a predictable response to attenuation of inflammation. Finally, in clinical practice, the current advice on the use of lipid profiles in any patient with RA is [33] to measure both total cholesterol and HDL cholesterol and to use the total cholesterol: HDL cholesterol ratio in conjunction with other established risk factors for the calculation of absolute CV risk, and [27] to treat accordingly when the absolute CV risk is high [29].…”

Standards of therapy of psoriatic arthritis

“…На 9 пациентах ПсА с активным артритом коленных суставов показано значимое снижение уровня регуляторов ангиогене-за (СЭФР и АП-2) в синовии после трех инфузий ИНФ в дозе 5 мг/кг. У 12 больных ПсА на фоне лечения ИНФ в режиме монотерапии через 6 и 12 месяцев значимо уменьшилась концентрация мат-риксных металлопротеиназ -9 и -2 (ММП-9 и ММП-2), СЭФР и Е-селектина в сыворотке и коже [75][76][77].…”