Lipid profile changes in patients with rheumatic diseases receiving a treatment with TNF-α blockers: A meta-analysis of prospective studies

Abstract

Background. Some studies showed an anti-atherogenic effect of TNF-α blockers on lipid profile, but these data have been challenged.

Objective. To perform a meta-analysis on lipid profile changes induced by TNF-α blocker treatment.

Methods. Prospective studies on rheumatic patients receiving TNF-α blockers and providing before-and-after treatment values of triglycerides (TGs), total cholesterol (TC), HDL-cholesterol (HDLc), LDL-cholesterol (LDLc), and atherogenic index (AI) were included. Standardized mean differences (SMD) in lipid profile were analyzed at short-term (2–12 weeks), middle-term (13–24 weeks), and long-term (25–52 weeks) assessments.

Results. Thirty articles (1707 patients) were included. TNF-α blockers determined an increase in TC at short-term, middle-term, and long-term assessments (SMD: 0.20 mmol/L [95% CI: 0.04, 0.35]; SMD: 0.27 mmol/L [95% CI: 0.08, 0.46]; SMD: 0.22 mmol/L [95% CI: 0.01, 0.43]). HDLc increased only at the short-term assessment (SMD: 0.19 mmol/L [95% CI: 0.10, 0.28]), and TGs achieved a significant increase at the long-term assessment (SMD: 0.19 mmol/L [95% CI: 0.04, 0.34]). LDLc and AI were not affected by TNF-α blocker treatment.

Conclusions. Slight but significant increases in TC occurred without any significant change in LDLc and AI. Changes in HDLc and TGs were not consistent among the different time point assessments. These quantitative changes in lipid profile do not seem to be able to explain cardiovascular risk improvement reported in patients receiving TNF-α blockers. Further studies on other mechanisms are needed to address this issue.

Key words::

• Lipid profile
• rheumatic patients
• TNF-α blockers

Acknowledgements

M.N.D.D.M. and F.D. conceived and designed the study, performed statistical analysis, interpreted results, and drafted the manuscript; R.P., A.D.M., R.L., and P.A. acquired clinical data and drafted the manuscript. All authors read and approved the final version of the manuscript.

M.N.D.D.M. and P.A. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

All the members of the CaRRDs study group* were involved in literature search, organization of the work, and editing of the manuscript. All authors revised and approved the present version of this manuscript and approved the mention of their names in the article.

The authors want to thank Professor Solbritt Rantapää Dahlqvist for promptly providing original study data when contacted by e-mail.

Declaration of interest: The authors report no conflicts of interest. No funding and economic support has been received for this study.