J Rheum Dis.  2023 Oct;30(4):234-242. 10.4078/jrd.2023.0030.

Changes in the cholesterol profile of patients with rheumatoid arthritis treated with biologics or Janus kinase inhibitors

• Koh JH
• Lee BW
• Kim WU

• KMID: 2546239
• DOI: http://doi.org/10.4078/jrd.2023.0030

Abstract

Objective
To assess the effects of biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) on lipid profiles in patients with moderate-to-severe rheumatoid arthritis (RA).
Methods
This retrospective single-center observational study included patients with RA taking a tumor necrosis factor-α inhibitor (TNFi), abatacept, tocilizumab, or a Janus kinase inhibitor (JAKi) for at least 6 months. Changes in lipid profile were assessed at 6 months after the start of treatment, and associations between changes in lipid profiles and clinical efficacy, concomitant medications, and comorbidities were evaluated.
Results
This study included 114 patients treated with TNFi, 81 with abatacept, 103 with tocilizumab, and 89 with JAKi. The mean percentage change (from baseline to 6 months) in total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C levels was higher in those taking tocilizumab and JAKi than in those taking TNFi and abatacept. A significant change in non-HDL-C was associated with JAKi (versus TNFi: odds ratio [OR], 3.228; 95% confidence interval [CI], 1.536~6.785), tocilizumab (versus TNFi: OR, 2.203; 95% CI, 1.035~4.689), and statins (OR, 0.487; 95% CI, 0.231~1.024). However, changes in disease activity in 28 joints were not associated with a significant change in non-HDL-C.
Conclusion
Tocilizumab- and JAKi-associated increases in serum non-HDL-C levels were observed regardless of changes in disease activity. Statins are recommended for RA patients showing a significant increase in cholesterol levels after initiating biological and targeted synthetic DMARDs.

Keyword

Rheumatoid arthritis; Cholesterol; Antirheumatic agents

Figure

• 

  Fig. 1 Flow diagram showing the patients analyzed in this study. Overall, 576 patients with rheumatoid arthritis were screened, and 497 who had taken and maintained biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for at least 6 months were included. Patients were divided into four treatment groups: tumor necrosis factor-α inhibitor (TNFi), abatacept, tocilizumab, and Janus kinase inhibitor (JAKi). Patients tested with the standard lipid profile when they initiated b/tsDMARDs treatment, and who were followed-up for 6 months, were included in the final analysis. The standard lipid profile included total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride. csDMARD: conventional synthetic DMARDs, DAS28: disease activity score in 28 joints.

• 

  Fig. 2 Factors predisposing patients to a significant change in non-high-density lipoprotein cholesterol levels at 6 months (the multivariate model was adjusted for age and sex). NSAIDs: non-steroidal anti-inflammatory drugs, JAKi: Janus kinase inhibitor, TNFi: tumor necrosis factor-α inhibitor.

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