DYNAMICS OF TRADITIONAL MODIFIABLE RISK FACTORS, TOTAL CARDIOVASCULAR RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS ON LONG-TERM IL-6 RECEPTOR ANTAGONIST TREATMENT

Abstract

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: The effect of an inhibitor of interleukin (IL)-6 receptors on the state of the cardiovascular system in patients (pts) with rheumatoid arthritis (RA) remains poorly understood.Objective: To study the effect of therapy with an inhibitor of IL-6 receptors, tocilizumab (TCZ), on the dynamics of modifiable risk factors (RF), total cardiovascular risk in RA pts during a 12-month (m) follow-up period. METHODS: The study included 40 pts with active RA (33 women/7 men) with ineffectiveness and/or intolerance to basic anti-inflammatory drugs (DMARDs); the median age was 55[49;64]years, the duration of the disease — 102[48;162]m; DAS28 6.2[5.5;6.7]points; all pts were seropositive for rheumatoid factor, 80% for antibodies to cyclic citrullinated peptide. Pts received TCZ 8mg/kg therapy every 4 weeks: 52% received TCZ monotherapy, 48% received combined TCZ therapy with DMARDs. All pts underwent an assessment of traditional RF and were determined plasma total cholesterol (TC), HDL-C, LDL-C, and triglyceride (TG) levels. The total cardiovascular risk was calculated using the mSCORE. RESULTS: After 12m of TCZ therapy, a decrease in disease activity was noted: remission was observed in 64% (n=25) of pts, low disease activity - in 31% (n=12). DAS28, HAQ, CRP and ESR concentrations decreased significantly. ? high frequency of traditional RF was found in RA pts: dyslipidemia - 67%, arterial hypertension - 65%, overweight - 55%, burdened heredity for cardiovascular diseases - 35%, smoking - 15%. Every third pts had a combination of three or more traditional RF. After 12 m of TCZ therapy, the frequency of traditional RF did not significantly change, there was an increase in BMI by 2%, an increase in the concentration of HDL-C in serum by 27%, a decrease in the atherogenic index (IA) by 28% (p<0.01). Moreover, an increase in the level of HDL-C by the finish was found in pts regardless of statin therapy. Changes in the concentration of other lipids during the observation, including during therapy with statins, were not observed. A negative correlation the dynamics of the levels of ?TC and ?CRP (R=−0,37, p<0.05), ? LDL-C and ?CRP (R=−0,42, p<0.01) was found. A very high cardiovascular risk according to the SCORE scale was determined in 78% of pts, moderate - in 2%, and low - in 20% of pts. The distribution of pts by mSCORE value and level of cardiovascular risk were not documented after 12m of TCZ therapy. CONCLUSIONS: After 12 m of TCZ therapy resulted in decreased RA activity, increased the level of HDL-C, IA, BMI; the frequency of traditional RF and the total cardiovascular risk did not change. Despite the very high risk of developing CVD associated with the inflammatory activity of RA, the accumulation of traditional RF and their combination. Insufficient effectiveness of statin therapy was revealed. CLINICAL IMPLICATIONS: cardiovascular risk, rheumatoid arthritis, therapy with an inhibitor of IL-6 receptors DISCLOSURES: No relevant relationships by Elena Gerasimova, source=Web Response No relevant relationships by Yulia Gorbunova, source=Web Response No relevant relationships by Alexandra Martynova, source=Web Response No relevant relationships by Tatiana Popkova, source=Web Response