Abstract
In the present study we evaluated how systemic arterial hypertension (SAH), dyslipidemia and diabetes mellitus influence the efficacy, safety and retention rate of biological disease-modifying anti-rheumatic drug (bDMARD) treatment in rheumatic musculoskeletal disorders (RMDs). The charts of RMD patients treated with the first-line bDMARD were reviewed, collecting data on safety, efficacy and comorbidities at prescription (baseline, BL), after 6 months (6M) and at last observation on bDMARD (last observation time, LoT). In 383 RMD patients, a higher rate of adverse events at 6M (p = 0.0402) and at LoT (p = 0.0462) was present in dyslipidemic patients. Patients who developed dyslipidemia or SAH during bDMARD treatment had similar results (dyslipidemia p = 0.0007; SAH p = 0.0319) with a longer bDMARD retention as well (dyslipidemia p < 0.0001; SAH p < 0.0001). SAH patients on angiotensin converting enzyme inhibitors (ACEis) or angiotensin-II receptor blockers (ARBs) continued bDMARDs for longer than non-exposed patients (p = 0.001), with higher frequency of drug interruption for long-standing remission rather than inefficacy or adverse reactions (p = 0.0258). Similarly, dyslipidemic patients on statins had a better bDMARD retention than not-exposed patients (p = 0.0420). In conclusion, SAH and dyslipidemia may be associated with higher frequency of adverse events but a better drug retention of first-line bDMARD in RMDs, suggesting an additional effect of ACEis/ARBs or statins on the inflammatory process and supporting their use in RMD bDMARD patients with SAH/dyslipidemia.
Highlights
In patients with rheumatic musculoskeletal diseases (RMDs), biological disease-modifying anti-rheumatic drugs are currently an efficient therapeutic choice to achieve disease remission
The aim of this study was to evaluate the effect of systemic arterial hypertension (SAH), dyslipidemia and diabetes on the efficacy, safety and retention rate of the first biological disease-modifying anti-rheumatic drug (bDMARD) in RMD, and to verify a possible effect of the concomitant medications used for the treatment of comorbidities
Out of 1234 clinical charts, 77 (6.24%) were excluded due to missing data; 416 (33.71%) were treated with a bDMARD for other diseases other than rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) in off-label regimen; 31 (2.51%) patients lacked data for the first 6 months of therapy and 327 (26.50%) patients with RA, PsA or AS were not treated with a bDMARD
Summary
In patients with rheumatic musculoskeletal diseases (RMDs), biological disease-modifying anti-rheumatic drugs (bDMARDs) are currently an efficient therapeutic choice to achieve disease remission. It is well known that these drugs may interfere with glucose homeostasis, lipoprotein profile and systemic arterial blood pressure. Data on systemic arterial hypertension (SAH) are controversial. A Japanese study demonstrated that infliximab reduced daytime blood pressure [1], while other data showed no effect of tumor necrosis factor inhibitor (TNFi) antibodies on blood pressure, neither systolic nor diastolic [2]. It was clear that TNFis increased levels of total cholesterol (TC), high-density lipoproteins (HDL), and, to a lesser extent, triglycerides (TG), without any effect on low-density lipoproteins (LDL) [3,4,5,6]. TNFi therapy reduced insulin levels and improved insulin resistance and insulin sensitivity [8]
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