In Psoriatic Arthritis, Long-Term anti-TNF Therapy Has Deleterious Effect on Lipid Profile

SAN DIEGO, CA—A prospective study to evaluate the long-term effect of anti-tumor necrosis factor (TNF) therapy on lipid profile in patients with psoriatic arthritis has identified a specific deleterious pattern, investigators reported at the 2013 ACR/ARHP Annual Meeting.

This “novel demonstration… reinforces the importance of this cytokine as a potent lipid metabolism regulator and emphasizes the recommendation for close monitoring and a more vigorous intervention in this modifiable cardiovascular risk factor,” Julio C. B. Moraes, MD, of the Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, and colleagues emphasized.

Patients with psoriatic arthritis have increased cardiovascular morbidity and mortality; however, to date no studies have examined the lipid profile among those on long-term anti-TNF therapy.

To address this question, the investigators prospectively enrolled 32 consecutive patients with psoriatic arthritis eligible to receive anti-TNF therapy. “All patients were treated with TNF blockers, and they were evaluated for lipid profile, atherogenic index, body mass index (BMI), waist circumference, and disease parameters at baseline and at 104 weeks after treatment,” they noted.

The lipoprotein risk level for coronary heart disease was that defined by the National Cholesterol Education Program (total cholesterol >240mg/dL, LDL-cholesterol >160mg/dL, and HDL-cholesterol <40mg). Patients using statins at study entry were excluded; however, statin initiation was allowed during the study.

A significant increase in levels of total cholesterol (177±39mg/dL vs. 195±45mg/dL, P=0.002) and LDL-cholesterol (105±34mg/dL vs. 117±40mg/dL, P=0.007) was observed, despite the introduction of statins in approximately 25% of patients.

No changes were found in concentration of HDL-cholesterol (48±12mg/dL vs. 50±12mg/dL, P=0.26) or triglycerides [105 (69-160)mg/dL vs. 112 (92-183)mg/dL P=0.06], in atherogenic index (3.9±1.4 vs. 4.1±1.3, P =0.48), BMI (28.4±5.2kg/m2 vs. 29.1±5.7kg/m2, P =0.62), or waist circumference (92.2±15cm vs. 97.8±14.9cm, P=0.230).

The frequency of patients with high-risk levels for total cholesterol (6.3% vs. 28.1%, P=0.023) and high/very high LDL-cholesterol (6.3% vs. 28.1%, P=0.023) significantly increased from entry to 104 weeks, whereas no changes in frequency of HDL-cholesterol or triglyceride classification rates were observed.

Anti-TNF treatment was found to improve the inflammation parameters C-reactive protein (P<0.001) and erythrocyte sedimentation rate (P<0.001). “Close monitoring and a more vigorous intervention in this modifiable cardiovascular risk factor must be recommended,” noted Dr. Moraes.
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