Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Metanalysis on the Effect of TNF-Inhibitors on Lipid Profile.

Daien1,  Claire Immediato, Duny3,  Yohan, Barnetche2,  Thomas, Morel1,  Jacques

Département de Rhumatologie, Hôpital Lapeyronie, Montpellier, France
Département de Rhumatologie, Hôpital Pellegrin, Bordeaux, France
Institut Universitaire de Recherche Clinique, Service de Biostatistiques, Epidémiologie et Santé Publique, Montpellier, France

Background:

Patients with Rheumatoid arthritis (RA) have an increased risk for cardiovascular diseases. Lipidic changes related to inflammation have been described in RA. TNF inhibitor (TNFi) therapy is an effective treatment that controls inflammation.

Objective:

To assess modification of lipid levels after initiation of TNFi in RA patients.

Methods:

The search strategy used Medline database until March 2010 and abstracts of 2009 EULAR/ACR congress. The Mesh terms used were: ("Lipids"[Mesh] OR "Dyslipidemia"[Mesh]) AND "Arthritis, Rheumatoid"[Majr:NoExp] AND ("TNFR-Fc fusion protein"[Substance Name] OR "infliximab"[Substance Name] OR "adalimumab"[Substance Name] OR "anti-TNF"). Values of total cholesterol (TC), LDL, HDL, triglycerides (TG), atherogen index (AI), and apoB/A were collected before and after TNFi initiation. Three time-points were defined as following: short term from 2 weeks to 2 months, mid-term at 3 months and long term from 6 to 12 months. Paired-data statistic analysis was performed with the logiciel Comprehensive Metanalysis®. Standardized mean differences were obtained using fixed or random effects model (Peto and Dersimonian & Laird method respectively). Random effects model was used when there was evidence of heterogeneity. The percentage of variability beyond chance was estimated using the I2 statistic. Publication biais was assessed using the Egger's test. The Trim and Fill Analysis for publication biais was performed using Duval and Tweedie's method.

Results:

The search led to 31 articles and 1 ACR abstract. Sixteen articles were excluded as they were out of topic or reviews/comments. Three other articles were also excluded because of missing p-values and/or confidence intervalls. Thus, 13 studies were included for the different meta-analyses. Ten of them included patients only treated with monoclonal antibodies, 1 with etanercept and two with respectively 47 and 21% of soluble receptors. The follow-up varied from 2 weeks to 2 years. TNFi were found to increase HDL levels at short term (+0.4 mmol/L; CI95% 0.3–0.5; p<0.0001; I2 4.4%), mid-term (+0.4 mmol/L, CI95% 0.2–0.6; p<0.0001; I2 0%) and long term (+0.3 mmol/L; CI95% 0.1–0.4; p<0.0001; I2 36%) as well as TC (short term: +0.4mmol/L; CI95% 0.3–0.5; p<0.0001, I2 0%; mid-term: +0.2 mmol/L; CI95% 0.1–0.3; p=0.002; I2 34%; long term: +0.2; CI95% 0.0–0.3; p=0.02; I2 25%). At short term, LDL levels were also increased (+0.4mmol/L; CI95% 0.3–0.6; p<0.0001; I2 0%) but not at mid-term (p=0.88; I2 55%) or long term (p=0.83; I2 72%). AI did not variate at short (p=0.3; I2 38%) and long term (p=0.3; 47%). TG levels increased at short term (+0.2; CI95% 0.0–0.3; p=0.009, I2 0%) and long term (+0.2; CI95% 0.1–0.3; p=0.03; I2 55%). ApoB/A tended to decrease at mid-term (-0.1; CI95%-0.3–0.0; p=0.08; I2 50%) and decreased at long term (-0.3 mmol/L; CI95%-0.5 –0.1; p<0.0001; I2 0%). No publication biais were found except for 4 analyses. These analyses remained significant after performing Duval and Tweedie method.

Conclusion:

Initiation of TNFi led to a persistant increase of TC and HDL. LDL and AI remained unchanged at long term. TG were increased and apoB/A decreased at long term after initiation of TNFi.

To cite this abstract, please use the following information:
Daien, Claire Immediato, Duny, Yohan, Barnetche, Thomas, Morel, Jacques; Metanalysis on the Effect of TNF-Inhibitors on Lipid Profile. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :393
DOI: 10.1002/art.28162

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