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A systematic review of the effect of TNF-α antagonists on lipid profiles in patients with rheumatoid arthritis

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Abstract

Atherosclerosis plays a key role in cardiovascular disease in patients with rheumatoid arthritis (RA). Although therapy with TNF-α antagonists has resulted in dramatic improvement in the prognosis of RA, its effects on circulatory lipids are unclear. We conducted a systematic review of the literature to summarize the available evidence on lipid profile modification in patients with RA treated with TNF-α antagonists, with extensive searches in PubMed, the Cochrane Collaboration database (Central), and SCOPUS. Twenty-four observational studies met the inclusion criteria; 12 included only patients with RA treated with infliximab and three, patients with RA treated with adalimumab. The other nine included a mix of patients with various rheumatic diseases, or receiving one of several TNF-α antagonists. Eleven studies found a statistically significant increase in total cholesterol (TC) and high-density lipoprotein (HDL); six of 20 found significant increases in triglycerides (TG). Four of 13 studies found a statistical increase in low-density lipoprotein. No major changes were observed for ApoB/ApoA1 ratios. A small trend to increased TC was observed in patients receiving TNF-α antagonists, mostly due to an increase in HDL. There was a small trend to increased TG, and no changes in ApoB/ApoA1 ratio. The clinical impact of these findings is unclear, and further studies are needed to clarify the role of these lipid changes on cardiovascular morbidity in RA.

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Acknowledgments

Dr. Suarez-Almazor has a K24 career award from the National Institute for Arthritis, Musculoskeletal and Skin Disorders (NIAMS) and is the Director of the Houston Center for Education and Research on Therapeutics funded by the Agency for Health Quality and Research (CERTs; U18 HS016093).

Disclosure

Dr. Suarez-Almazor has received speaking honoraria from Bristol-Meyer-Squibb, Amgen, and Roche.

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Authors and Affiliations

  1. Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St, Unit 1465, Houston, TX, 77030, USA

    Eduardo Nicolas Pollono, Maria A. Lopez-Olivo & Maria E. Suarez-Almazor

  2. Unidad de Investigación, Sociedad Española de Reumatología, Marqués del Duero 5, 28001, Madrid, Spain

    Juan Antonio Martinez Lopez

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  1. Eduardo Nicolas Pollono
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  2. Maria A. Lopez-Olivo
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Correspondence to Maria E. Suarez-Almazor.

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Pollono, E.N., Lopez-Olivo, M.A., Lopez, J.A.M. et al. A systematic review of the effect of TNF-α antagonists on lipid profiles in patients with rheumatoid arthritis. Clin Rheumatol 29, 947–955 (2010). https://doi.org/10.1007/s10067-010-1405-7

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  • DOI: https://doi.org/10.1007/s10067-010-1405-7

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