Lipid Profile Changes in Patients With Chronic Inflammatory Arthritis Treated With Biologic Agents and Tofacitinib in Randomized Clinical Trials: A Systematic Review and Meta‐Analysis

Abstract

Objective. To analyze lipid changes in patients with rheumatoid arthritis (RA) and patients with spondyloarthritis (SpA) treated with biologic agents or tofacitinib in randomized clinical trials (RCTs).Methods. A systematic literature search was performed, using the Medline, Embase, Cochrane Library, and Web of Knowledge databases. Meta-analyses were performed using random-effects models to assess changes in the percentage of patients with abnormal lipid values or in the mean percentage of increase in the cholesterol and triglycerides levels.Results. Conclusion. In patients with RA treated with tocilizumab or tofacitinib but not with TNF antagonists, moderate changes in lipids are observed. Whether these changes pertain to the control of inflammation or to the mechanism of action of the biologic agents or tofacitinib remains undetermined.Rheumatoid arthritis (RA) and the spondyloarthritides (SpA) ankylosing spondylitis and psoriatic arthritis have an important impact on a patient's wellbeing, related partly to joint damage, disability, and poor quality of life but also to increased cardiovascular morbidity and mortality (1-3). The most important cause of death in RA and SpA is cardiovascular disease (4-6).

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

“…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 . However, it is important to keep in mind that although lipid changes observed in patients following the successful antiinflammatory treatment may reflect normalization of an "inflammatory dyslipidemia," as noted by the authors, limited data exist about the effect of TNF-α inhibition on hard clinical outcomes including CV events and mortality in patients with psoriatic disease.…”

According to the Materials of the 2015/2016 New European League Against Rheumatism (Eular) Guidelines for Reducing Cardiovascular Risk in Patients With Inflammatory Arthritis: General Characterization and Discussion Problems

“…Применение ингибиторов ФНОα и БПВП (в основном MT) ассоциируется с увеличением концентрации ОХС, ХС ЛПНП и, в большей степени, ХС ЛПВП, что улучшает от-ношение ОХС/ХС ЛПВП [57][58][59][60][61][62][63][64][65]. В исследованиях сооб-щалось о положительном эффекте РТМ, тоцилизумаба и тофацитиниба на показатели липидного спектра крови [47,[66][67][68][69][70][71][72]. Однако общий эффект лечения этими препа-ратами проявляется в увеличении уровней липидов крови без изменений отношения ОХС/ХС ЛПВП [57,[68][69][70][71][72].…”

“…В исследованиях сооб-щалось о положительном эффекте РТМ, тоцилизумаба и тофацитиниба на показатели липидного спектра крови [47,[66][67][68][69][70][71][72]. Однако общий эффект лечения этими препа-ратами проявляется в увеличении уровней липидов крови без изменений отношения ОХС/ХС ЛПВП [57,[68][69][70][71][72]. ГИБП способствуют более выраженному увеличению со-держания липидов и липопротеидов крови по сравнению с БПВП.…”

“…Статины эффективны для снижения уровней атеро-генных липидов и липопротеидов у пациентов, получав-ших тоцилизумаб или тофацитиниб [71][72][73]. Ранее было показано, что отношение ОХС/ХС ЛПВП является луч-шим предиктором риска ССЗ при РА, чем отдельные ли-пидные показатели [74].…”

Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations

“…This procedure should be repeated when DMARDs are initiated due to the impact of biologic agents on lipid profiles [Souto et al 2015] .…”