RA
The Effect of TNF-alpha Blocking Therapy on Lipid Levels in Rheumatoid Arthritis: A Meta-Analysis

https://doi.org/10.1016/j.semarthrit.2011.04.003Get rights and content

Objectives

Changes in the lipid profile have been described in patients with rheumatoid arthritis (RA) following therapy with tumor necrosis factor (TNF)-alpha blocking agents. However, thus far, results have been inconsistent. Therefore, we investigated changes in lipid levels after TNF-alpha blocking therapy using meta-analysis of published data.

Methods

The literature was searched to identify studies assessing changes in total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol, triglycerides, atherogenic index (ie, TC/HDLc ratio), and apolipoprotein levels in response to TNF-alpha blocking therapy. Weighted mean levels of lipids at different time points and subsequent changes in these lipid levels between these time points were calculated with multivariate linear mixed models.

Results

Data were available on TC in 15 studies encompassing 766 RA patients and on HDLc in 14 studies encompassing 736 RA patients. TC increased significantly (maximum increase of 10%) and HDLc increased significantly in the first 2 to 6 weeks of therapy (maximum increase of 7%), after which it remained more or less stable. The atherogenic index did not significantly change over time. There was too limited information to evaluate changes in other lipids and apolipoproteins.

Conclusions

TNF-alpha blocking therapy has a modest effect on TC and HDLc levels in RA patients with no significant overall effect on the atherogenic index. Whether TNF-alpha blocking effects on qualitative lipid changes (structure and function) are more relevant to their presumed vascular benefits requires further study.

Section snippets

Search and Selection-Strategy

A systematic search of the literature published until May 2010 was conducted in MEDLINE, Cochrane library, and EMBASE to identify all articles investigating lipid profiles in RA patients treated with TNF-alpha blocking agents. Search terms were used in every possible spelling, as synonyms, acronyms, key- or text words. The following key words were used in all fields: (“arthritis, rheumatoid”) AND (“cholesterol” OR “HDL” OR “LDL” OR “triglycerides” OR “atherogenic index” OR “apolipoprotein A”)

Included Studies and Population Characteristics

For the present meta-analyses 15 studies with data on TC in 766 patients and 14 studies with data on HDLc in 736 patients were available that met our inclusion criteria (12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26) (Table 1). All included studies used data of patients initiating TNF-alpha blocking therapy for the first time and were thus TNF-alpha blocking agent-naïve at baseline. Five studies had a study population of more than 50 individuals (14, 15, 19, 25, 26). Mean follow-up

Discussion

To date, some systematic reviews have focused on the effect of TNF-alpha blocking therapy on lipid levels in RA, yet none have produced a summary estimate of the changes in lipid levels following TNF-alpha blocking therapy (2, 31, 32, 33, 34). The present study therefore is the first to describe a summary estimate of 10% increase for TC and 7% increase for HDLc within a period of 6 months. In addition, results from available studies were more consistent than originally perceived, as a rise in

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  • Cited by (0)

    The authors declare that there are no competing interests. However, the Departments of Rheumatology of the VU Medical Centre and Jan van Breemen Research Institute have both received funds for educational and research purposes from Pfizer, Abbott, UCB, MSD, BMS, and Roche. However, they had no involvement in the study design, in the collection, analysis, and interpretation of the data, in the writing of the report, or in the decision to submit the paper for publication.

    NS has received research and lecture grants from Roche; MN has received speaking grants, ad-hoc consultancy grants, and congress support from Pfizer, Abbott, UCB, MSD, BMS, and Roche.

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