Background/Purpose:  Risk of cardiovascular (CV) disease is increased among rheumatoid arthritis (RA) patients, and high inflammatory burden associated to traditional CV risk factors appears to be the major drivers. Inflammation has a deep effect on metabolism so that lipids may have paradoxical implications in RA, being lower cholesterol levels associated to increased CV risk. Different biologic treatments are effective in controlling inflammation and decreasing the number of CV events, but their effects on lipid profile are conflicting or not well documented. Therefore, the aim of this study was to examine any change between different biologic agents on lipid profile of RA patients.

Methods:  Patients affected by RA, according to the 2010 EULAR/ACR classification criteria, exposed at least for one year to RA approved dosage regimens of Abatacept (ABA), Infliximab (INF), or Tocilizumab (TCZ) as first line treatment, or Rituximab (RTX) as second line agent, were retrospectively enrolled in this study. Before and after 24 and 52 weeks from treatment start lipid profile (Total Cholesterol, HDL-C and LDL-C, Tryglicerides) and DAS28 were assessed. The odds ratio (OR) for which treatment approach had the best benefit on patients lipid profile was calculated.

Results: A total of 204 (F/M: 179/25; mean age 54±12 years; mean disease duration 7±3 years) patients were eligible for this study and among them 86 (42%) had received INF, 42 (20.5%) TCZ, 37 (18.1%) ABA, and 39 (19.1%) RTX. After 52 weeks of treatment 101 (49.7%) patients achieved the DAS28-remission: 36 INF, 24 TCZ, 21 RTX, 16 ABA. Moreover we observed a mean increasing of 13% in cholesterol fractions levels compared to baseline (+10% for INF and RTX, +15% for ABA, and +18% for TCZ), with no significant changes in Total Cholesterol/HDL ratio. Among those patients that achieved DAS28-remission, in 63% of TCZ, 50% of INF, 45% of RTX, and 38% of ABA treated patients, respectively, a condition of hyperlipidemia was detectable. Compared to ABA group considered as reference, patients that had received TCZ presented an OR of 2.66 (95%CI 1.07-6.64; P=0.03) to develop hyperlipidemia, while patients that had received INF or RTX presented and OR of 1.64 (95%CI 0.74-3.61) and 1.40 (95%CI 0.56-3.51), respectively. No CV events have been detected during the follow-up period.

Conclusion:  We demonstrated that a good disease activity control, and consequently an inflammation decrease, affects lipid profile independently from CV risk. Different biologic agents may have unlike impact on lipid levels, probably by a cytokine modulation on cholesterol metabolism.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-different-biologic-agents-on-lipid-profile-in-rheumatoid-arthritis/