J Rheum Dis.  2024 Jan;31(1):41-48. 10.4078/jrd.2023.0040.

Impact of anti-tumor necrosis factor treatment on lipid profiles in Korean patients with ankylosing spondylitis

• Kwon I
• Choi N
• Shin JH
• Lee S
• Nam B
• Kim TH

• KMID: 2549635
• DOI: http://doi.org/10.4078/jrd.2023.0040

Abstract

Objective
To investigate the effects of anti-tumor necrosis factor (TNF) treatment on lipid profiles and identify risk factors for an increase in total cholesterol (TC) after the anti-TNF treatment in ankylosing spondylitis (AS) patients.
Methods
This retrospective cohort study analyzed AS patients who received the first-line anti-TNF treatment. Patients with at least nine months of follow-up were included; those who were under 18 years or on any lipid-lowering agent were excluded. A linear mixed model was used to assess the impact of anti-TNF inhibitors on disease activity and lipid profile (TC, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides [TG]). Univariable and multivariable linear regression were used to identify risk factors for an increase in TC after 3 months of anti-TNF treatment.
Results
A total of 315 AS patients were enrolled (78.1% male, median age 32.0 [26.0~41.0]). TC, HDL, and TG levels significantly increased particularly within the first 3 months of anti-TNF treatment, while LDL level did not show significant changes. Changes in inflammatory markers and lipid particles (TC, LDL, TG) were correlated over time, but HDL showed no significant correlation. Older age, higher baseline erythrocyte sedimentation rate, and lower baseline LDL level were related to an increase in TC after 3 months of the anti-TNF treatment.
Conclusion
In AS patients, anti-TNF treatment has been found to increase lipid particles, potentially due to its anti-inflammatory effects. Future research should explore the underlying mechanism and the clinical implications of dyslipidemia, particularly the occurrence of cardiovascular events, following anti-TNF treatment in AS patients.

Keyword

Ankylosing spondylitis; Tumor necrosis factor inhibitors; Dyslipidemias; Inflammation

Figure

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  Figure 1 Changes in proportion of dyslipidemia patients following anti-tumor necrosis factor treatment.

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  Figure 2 Changes in CRP and lipid particles after anti-tumor necrosis factor treatment. CRP: C-reactive protein, TC: total cholesterol, LDL: low-density lipoprotein, HDL: high-density lipoprotein, TG: triglyceride.

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