Does Treatment with TNF Inhibitors Affect Lipid Profile?

Tumor necrosis factor alpha (TNF-α) inhibitors worsen the lipid profile of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), according to new research. However, statin use improved low-density lipoprotein (LDL) levels.

To conduct their study, the researchers reviewed the medical records of 152 patients with RA, 90 with PsA, and 69 with AS who were taking TNF-α inhibitors for at least 270 days between 2001 and 2011.
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Patients were categorized into 3 subgroups based on their statin use: non-use, statin initiated during the study period, and statin initiated prior to and continued throughout the study period.

The researchers measured total cholesterol (TC), triglycerides (TG), LDL, high-density lipoprotein (HDL), and atherogenic index (AI) levels of all patients at baseline and at follow up visits at 0 to 6 months, 6 to 12 months, 12 to 18 months, and 18 to 24 months.

Overall, TNF-α inhibitors increased total cholesterol from 180.85 ± 2.12 mg/dl at baseline to 188.12 ± 2.35 mg/dl at the 0 to 6 month follow-up, and to 184.88 ± 2.09 mg/dl at the 18 to 24 month follow-up.

TNF-α inhibitors were also associated with an increase in triglyceride and atherogenic index levels.

However, in patients who were taking statins before and during the study period, TNF-α inhibitors significantly lowered their LDL level from 119.97 ± 2.86 mg/dl at baseline to 104.02 ± 3.57 mg/dl at the 18 to 24 month follow-up.

“TNF-α inhibitor treatment was associated with a significant increase in TC and TG levels and the AI,” the researchers concluded. “Adding statins to the treatment was associated with a significant decrease in LDL levels.”

—Amanda Balbi

Reference:

Hassan S, Milman U, Feld J, et al. Effects of anti-TNF-α treatment on lipid profile in rheymatic diseases: an analytical cohort study [published online November 10, 2016]. Arthritis Res Ther. doi:10.1186/s13075-016-1148-1.