FRI0251 Comparison of lipid profile including high molecular weight adiponectin (HMW-AN) after treatment with three different biologics in the patients with bio-naïve rheumatoid arthritis (RA)

Abstract

Background Three different mode of action of biologics (adalimumab, tocilizumab and abatacept) have been shown to provide clinical benefits in the patients (pts) who did not adequately respond to methotrexate (MTX-IR) in RA. In several studies including our report, moderate increase in cholesterol and HMW-AN, which is an anti-atherogenic adipocytokine, after treatment with TNF inhibitors has been reported1). However, there was no report in terms of comparison of effect of biologics on lipid profile. Objectives The aim of this study is to compare the effect of TNF inhibitor (adalimumab), IL-6 inhibitor (tocilizumab) and abatacept on lipid metabolism, especially on AN, in MTX-IR, bio-naïve RA patients. Methods From the cohort of about 1,700 patients who received biologics in our institute, we evaluate the effect of MTX alone (52) or first line use of adalimumab (76), tocilizumab (27), abatacept (34) on lipid profile in MTX-IR pts whose LDL, HDL-C and AN at a series of 0, 24, 52wks were available. In order to remove the effect of prior biologics, corticosteroids (CS) and lipid-lowering agents, the pts who had received those drugs were excluded. Results The baseline characteristics of the 189 pts; average of age was 58.4 and disease duration was 74.5 months and there was no significant difference among 4 groups. The disease activity decreased dramatically in each group as shown in Table (0 vs 24, 52wks, *p<0.05, **p<0.01). Three biologics but not MTX alone increased LDL, HDL-C and HMW-AN at24 and kept the titer at 52 wks. There was no significant difference among biologics groups regarding the changes of lipid after the treatment. In addition, atherogenic index was not changed despite of increase of LDL-C. Baseline and changes of HMW-AN were not associated with type of biologics as well as disease activity. Conclusions Our data suggest inhibition of TNF, IL-6 and T cell activation increase both LDL and HDL-C at the same degree without change in atherogenic index. Furthermore these biologics might have preventive effect on the progression of arteriosclerosis by an increase of HMW-AN. MTX alone decrease disease activity as biologics do, but do not increase AN. Our data imply us that action of the biologics for lipid metabolism could be independent on inflammation in synovitis. In this study we excluded pts with CS, lipid-lowering agents and prior biologics. However, precise mechanism of these biologics on AN remained unclear, this is the first report regarding comparison of lipid profile in the patients treated with different biologics in RA. References Nishida K, Okada Y, Nawata M, Saito K, Tanaka Y. Endocr J. 2008 Disclosure of Interest: K. Saito Speakers bureau: Bristol-Myers Squibb, MSD K.K., Chugai Pharma Co., Ltd., Mitsubishi-Tanabe Pharma Co., Ltd., Abbott Japan Co., Ltd., Eisai Co., Ltd., K. Hanami: None Declared, S. Hirata: None Declared, S. Kubo: None Declared, M. Nawata: None Declared, K. Yamaoka: None Declared, S. Nakayamada: None Declared, K. Nakano: None Declared, Y. Tanaka Grant/research support...

The Impact of Biologics and Tofacitinib on Cardiovascular Risk Factors and Outcomes in Patients with Rheumatic Disease: A Systematic Literature Review

“…There were no changes from baseline reported for TC [ 16 , 17 , 21 , 23 , 25 ] and TG [ 17 , 21 , 23 , 25 ]. Saito et al [ 24 ] reported increase in both HDL-C and LDL-C, but two other studies reported no significant change [ 17 , 21 , 23 , 25 ]. There was no significant effect on BP [ 17 ], atherogenic index [ 16 ], AIx [ 16 – 18 , 21 , 23 , 25 ], CAVI [ 18 ], cIMT [ 16 ], and carotid artery plaques [ 16 ].…”

“…Data on patients with RA treated with adalimumab were obtained from five RCTs (four full-length articles [ 26 – 29 ] and three conference abstracts [ 30 – 32 ]), five PC studies (four full-length articles [ 33 – 36 ] and one conference abstract [ 37 ]), and six RC studies (four full-length articles [ 38 – 41 ] and two conference abstracts [ 19 , 24 ]). There was no effect on TC [ 27 , 33 , 36 , 40 ] or TG [ 33 , 36 , 40 ].…”

“…There was no effect on TC [ 27 , 33 , 36 , 40 ] or TG [ 33 , 36 , 40 ]. In some studies there were significant increases in HDL-C [ 24 , 26 , 29 , 32 ] and LDL-C [ 24 , 26 , 32 ], but there were others that reported no significant change in these lipids [ 33 , 36 , 40 ]. There was significant reduction in CRP [ 27 , 33 , 36 ], AIx [ 27 , 30 ], CAVI [ 27 , 30 ], serum amyloid A (SAA) [ 26 , 32 ], secretory phospholipase A 2 (sPLA2) [ 26 , 32 ], and arterial stiffness [ 30 ].…”

“…Data on patients with RA treated with tocilizumab were obtained from ten RCTs (seven full-length articles [ 26 , 27 , 79 – 83 ] and five conference abstracts [ 16 , 30 , 32 , 84 , 85 ]), seven PC studies (six full-length articles [ 17 , 37 , 72 , 86 – 88 ] and one conference abstract [ 89 ]), and six RC studies (one full-length article [ 90 ] and seven conference abstracts [ 20 – 25 , 91 ]). Most studies reported significant increases in TC [ 16 , 21 , 23 , 25 , 27 , 79 – 81 , 83 – 86 , 90 , 91 ], HDL-C [ 22 , 24 , 26 , 32 , 79 , 85 , 92 ], LDL-C [ 21 , 23 – 26 , 32 , 81 , 85 , 92 ], and TG [ 21 , 23 , 25 , 79 , 86 , 92 ], although two PC studies reported no significant change from baseline [ 17 , 72 ] and one RCT reported that the increase in TC was reversible [ 79 ]. When measured, there was significant reduction in CRP levels [ 16 , 17 , 27 , 80 , …”

Cardiovascular Risk Assessment in Rheumatoid Arthritis: Accelerated Atherosclerosis, New Biomarkers, and the Effects of Biological Therapy

“…Assessing factors that influence cardiovascular risk, studies have not reported changes in TC, triglycerides, LDL-C, or HDL-C levels for abatacept [ 169 , 217 ]. There is one study showing an increase in LDL-C [ 218 ], while there two showing improvements in HDL-C, both quantitatively and qualitatively [ 218 , 219 ]. No significant modification in cIMT [ 169 , 220 ] or BP [ 169 ] was observed, while BMI showed an upward trend; however, insulin sensitivity appeared to be improved [ 221 ].…”