Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study.

Toka Alsulaim,Noor Alhassan,Abdullah Almutlaq,Hala Khalil,Tim Jansen

doi:10.1155/2021/5535486

Abstract

Objective To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events. Methods A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6–12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded. Results Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached high cholesterol levels ≥ 5.2 mmol/L and LDL ≥ 3.37 mmol/L in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), P 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, P 0.03). Conclusion There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.

Highlights

The interleukin-6 (IL-6) inhibitors, one of which is tocilizumab, a monoclonal autoantibody, has been studied and approved for rheumatoid arthritis treatment back in 2010 along with other autoimmune diseases including systemic-onset juvenile idiopathic arthritis, Castleman’s disease, multiple myeloma, systemic lupus erythematosus, and, lately, giant cell arteritis in 2017
Given that tocilizumab is an IL-6 inhibitor which blocks the IL-6 receptor, it was found that IL-6 levels appear to be increased after treatment, which suggests that the mechanism underlying dyslipidemia is due to the direct effect of IL-6 [4]
We identified adult patients aged ≥18 years old with a diagnosis of rheumatoid arthritis or juvenile idiopathic arthritis who have been initiated either on tocilizumab or other biologic treatment who at least have baseline lab results that include lipid profile prior starting the biologic treatment with follow-up duration interval after starting therapy in the clinic or day medical unit for a minimum of 6–12 months up to 3-5 years

Summary

Introduction

The interleukin-6 (IL-6) inhibitors, one of which is tocilizumab, a monoclonal autoantibody, has been studied and approved for rheumatoid arthritis treatment back in 2010 along with other autoimmune diseases including systemic-onset juvenile idiopathic arthritis, Castleman’s disease, multiple myeloma, systemic lupus erythematosus, and, lately, giant cell arteritis in 2017. It has been given either subcutaneously once weekly or every four weeks intravenously in a dose of 4-8 mg/kg and found to reduce disease activity, induce remission, and reverse joint damage in early stages of rheumatoid arthritis [1]. An open-labelled, phase 4 study conducted throughout 5 countries (Bahrain, Iran, Kuwait, Qatar, and UAE) between January 13, 2010, and June 20, 2011, did show a 10.5% increase in blood cholesterol among the 95 participants [6]

Methods

Results

Conclusion