"VSports手机版" Comparison of lipid and lipid-associated cardiovascular risk marker changes after treatment with tocilizumab or adalimumab in patients with rheumatoid arthritis

Abstract

Objective: Compare changes in lipids and lipid-associated cardiovascular (CV) risk markers in patients with rheumatoid arthritis (RA) treated with tocilizumab or adalimumab. Methods: Post-hoc analysis was performed in patients with RA who received tocilizumab intravenously every 4 weeks or adalimumab subcutaneously every 2 weeks for 24 weeks in the ADACTA trial. Lipid and lipid-associated CV risk biomarkers, including high-density lipoprotein-associated serum amyloid-A (HDL-SAA), secretory phospholipase A2 IIA (sPLA2 IIA) and lipoprotein(a) (Lp(a)), were measured at baseline and at week 8. Results: The study included 162 patients treated with tocilizumab and 162 patients treated with adalimumab; HDL-SAA and sPLA2 IIA were measured in a subpopulation of 87 and 97 patients, respectively. Greater increases in mean low-density lipoprotein cholesterol (LDL-C) (0. 46 mmol/L (95% CI 0. 30 to 0. 62)), high-density lipoprotein cholesterol (HDL-C) (0. 07 mmol/L (0. 001 to 0. 14)), total cholesterol (TC) (0. 67 mmol/L (0. 47 to 0. 86)), triglycerides (0. 24 mmol/L (0. 10 to 0. 38)) and TC:HDL ratio (0 VSports app下载. 27 (0. 12 to 0. 42)) occurred with tocilizumab from baseline to 8 weeks. HDL-SAA, sPLA2 IIA and Lp(a) decreased more with tocilizumab than adalimumab. Median changes from baseline to week 8 were –3. 2 and –1. 1 mg/L (p=0. 0077) for HDL-SAA and –4. 1 and –1. 3 ng/mL (p<0. 0001) for sPLA2 IIA; difference in adjusted means was –7. 12 mg/dL (p<0. 0001) for Lp(a). Similar results were observed in efficacy responders and non-responders per American College of Rheumatology and European League against Rheumatism criteria. Conclusion: LDL-C and HDL-C increased more with tocilizumab than adalimumab. HDL-SAA, sPLA2 IIA and Lp(a) decreased more with tocilizumab. Lipid change effects of interleukin-6 and tumour necrosis factor (TNF) inhibition, manifest by their net impact on lipids and lipoproteins, are not synonymous; the clinical significance is unclear and requires further study. Trial registration number: NCT01119859. ; post-results.