1265 - Effects of TNF-Alpha Inhibitors on Lipid Profile and on Sub-Clinical Atherosclerosis in Rheumatoid Arthritis. Systematic Review and Meta-Analysis

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Sylvain Mathieu1, Sarah Payet1, Bruno Pereira2, Eric Bruckert3 and Martin Soubrier2, 1CHU Gabriel Montpied, Clermont-Ferrand, France, 2CHU CLERMONT-FERRAND, Clermont-Ferrand, France, 3CHU Pitié-Salpêtrière, AP–HP, Paris
Presentation Number: 1265

Background/Purpose: Rheumatoid arthritis is associated with an increased cardiovascular risk that has been recently reported to be decreased by anti-TNF alpha, whose mechanisms remain uncertain.

Method: MEDLINE, EMBASE, the Cochrane Collaboration and congress abstracts were searched to identify all reports of interest published up to May 2010. All observational and case/controls studies assessing the short- (4 weeks), medium- (16 weeks) and long-term (52 weeks) effects of TNF alpha blockade (infliximab, adalimumab, etanercept) on lipid profile or intima-media thickness (IMT) or endothelial dysfunction in RA patients were included.

Result: Thirty publications and abstracts were included, which represented 1135 RA patients. We found no significant change in lipid profile, in both the short, medium and long term of treatment (Table 1). Anti-TNF alpha caused no significant change in the flow-mediated dilation and Augmentation Index, nor significant modification of IMT over time (0.73[0.68-0.79] mm at baseline, 0.68[0.54-0.82] after 16 weeks and 0.88[0.34-1.41] after one year; p=0.83). Anti-TNF alpha improved disease activity and systemic inflammation.

Conclusion: Despite a significant decrease in biological inflammation, anti-TNF alpha caused no change in intima-media thickness, endothelial dysfunction or lipid profile in RA patients.

Table 1. Differences in parameters of lipid profile after TNF blockade treatment

 

Baseline

4 weeks

16 weeks

52 weeks

p-value

TC, mmol/l

n=20

5.10[4.92-5.28]

n=11

5.31[5.11-5.50]

n=10

5.19[5.04-5.35]

n=2

5.17[4.88-5.47]

p=0.52

LDL, mmol/l

n=11

3.21[3.00-3.41]

n=5

3.24[2.80-3.69]

n=6

3.15[3.02-3.27]

n=2

3.07[2.96-3.18]

p=0.88

HDL, mmol/l

n=18

1.39[1.30-1.48]

n=11

1.45[1.35-1.55]

n=9

1.52[1.35-1.70]

n=3

1.53[1.45-1.62]

 

p=0.47 

TG, mmol/l

n=14

1.31[1.15-1.46]

n=8

1.34[1.14-1.55]

n=5

1.28[1.05-1.50]

n=1

0.94[0.82-1.06]

p=0.48

Atherogenic index

n=11

3.86[3.64-4.08]

n=6

4.18[3.57-4.79]

n=5

3.49[3.14-3.83]

n=2

3.48[2.93-4.04]

p=0.34

n=number of included studies. TC=total cholesterol; LDL=low density lipoprotein cholesterol; HDL=high density lipoprotein cholesterol; TG= triglycerides.

 


Keywords: anti-TNF therapy, arteriosclerosis, lipids and rheumatoid arthritis (RA)

Disclosure: S. Mathieu, None; S. Payet, None; B. Pereira, None; E. Bruckert, None; M. Soubrier, None.