Abstract
This study aimed to evaluate the impact of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) on lipid profile and atherogenic index of plasma (AIP) in rheumatoid arthritis (RA) patients and to compare the occurrence of dyslipidemia between patients using bDMARDs, tsDMARDs, or conventional DMARDs (cDMARDs). Data on lipid profile, AIP, and occurrence of dyslipidemia were collected from the Korean College of Rheumatology BIOlogics registry. A comparison was conducted between patients using bDMARDs (tumor necrosis factor (TNF)-α inhibitor, tocilizumab, abatacept), Janus kinase inhibitors (JAKis), and cDMARDs. The Kaplan-Meier method was used to compare the occurrence of dyslipidemia between groups, and hazard ratios (HR) were calculated using the cox proportional hazard method. The data of 917, 826, 789, 691, and 520 RA patients were eligible for analysis at the baseline, 1-year, 2-year, 3-year, and 4-year follow-ups, respectively. Baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were higher in the cDMARDs group, whereas AIP was comparable. During the 4-year follow-up, AIP was comparable between the groups. The occurrence of dyslipidemia did not show a significant difference when comparing the bDMARDs/tsDMARDs and cDMARDs groups (P=0.06) or the TNF-α inhibitor, tocilizumab, abatacept, JAKi, and cDMARD user groups (P=0.3). In the multivariate cox proportional hazard model, older age (HR=1.03, P=0.005) and concomitant hypertension (HR=2.21, P=0.013) were significantly associated with dyslipidemia occurrence. Long-term use of bDMARDs and tsDMARDs is relatively safe with regard to lipid profile, AIP, and the occurrence of dyslipidemia in RA patients. Key Points • The use of bDMARDs and tsDMARDs did not increase the risk of dyslipidemia than cDMARDs use in patients with RA. • AIP was comparable between bDMARDs user, tsDMARDs user, and cDMARDs user group in 4-year follow-up data. • Based on the present study, the long-term use of bDMARDs or tsDMARDs did not significantly deteriorate atherogenic lipid profile nor an increased risk of dyslipidemia in patients with RA.
Highlights
To evaluate the impact of biologic disease-modifying antirheumatic drugs and targeted synthetic DMARDs on lipid profile and atherogenic index of plasma (AIP) in rheumatoid arthritis (RA) patients, and to compare the occurrence of dyslipidaemia between patients using bDMARDs, tsDMARDs, or conventional DMARDs
For laboratory findings the inflammatory markers, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were significantly higher in the bDMARDs/tsDMARDs group than the conventional DMARDs (cDMARDs) group, whereas total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and TG levels were higher in the cDMARDs group
TC was higher in the cDMARDs group than the tumour necrosis factor-α (TNF-α) inhibitor group, and LDL-C was higher in the cDMARDs group than the tocilizumab group (Supplementary Table 1)
Summary
To evaluate the impact of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) on lipid profile and atherogenic index of plasma (AIP) in rheumatoid arthritis (RA) patients, and to compare the occurrence of dyslipidaemia between patients using bDMARDs, tsDMARDs, or conventional DMARDs (cDMARDs). Uncontrolled inflammation induces arthralgia, systemic symptoms such as fatigue, and chronically destroys articular structures [3]. These harmful results reduce the quality of life and range of motion in RA patients, and changes to the articular structure are irreversible. The causes of death in RA patients are not related to these symptoms or structural changes. The leading cause of death in these patients is cardiovascular disease (CVD) [5]
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