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

Figures & data

Table I. Characteristics of included studies.

Author	Study design	Population	Sex (M/F)	Mean age (y)	Drug	CCS	MTX	Statins	Outcomes	Follow-up
Cauza, 2002 (30)	Prospective cohort study	15 patients (7 RA, 8 PA)	5/10	56.7	Infliximab	5	8	NA	TC, HDLc, LDLc, TGs	2 wks
Irace, 2004 (31)	Prospective cohort study	10 RA patients	4/6	46 ± 12	Infliximab	10	10	0	TC, HDLc, TGs	2 and 6 wks
Popa, 2005 (32)	Double blind study	33 RA patients	NA	NA	Adalimumab	NA	0	NA	TC, HDLc, LDLc, TGs	2 wks
Vis, 2005 (33)	Prospective cohort study	69 RA patients	14/55	55 ± 13	Infliximab	32	62	0	TC, HDLc, TGs, AI	2 and 6 wks
Allanore, 2006 (34)	Prospective cohort study	56 RA patients	5/51	52 ± 14	Infliximab	56	53	0	TC, HDLc, LDLc, TGs, AI	6 and 30 wks
Seriolo, 2006 (29)	Prospective cohort study	34 RA patients	0/34	51.6 ± 7.9	Infliximab (n = 14); etanercept (n = 16); adalimumab (n = 4)	NA	NA	NA	TC, HDLc, TGs, AI	16 and 24 wks
Gonzalez-Juanatey, 2006 (35)	Prospective cohort study	8 RA patients	1/7	51 years (median)	Adalimumab	8	8	0	TC, HDLc, AI	2 and 12 wks
Dahlqvist, 2006 (36)	Prospective cohort study	52 RA patients	11/41	54.6 ± 12.5	Infliximab	28	40	0	TC, HDLc, LDLc, TGs	30, 54, 78, 94 wks
Spanakis, 2006 (37)	Prospective cohort study	26 AS patients	22/2	39.1 ± 8.1	Infliximab	0	11	0	TC, HDLc.	4, 12, and 18 wks
Spanakis, 2006 (37)	Prospective cohort study	24 RA patients	7/17	62.7 ± 10.1	Infliximab	6	21	0	TC, HDLc.	4, 12, and 18 wks
Spanakis, 2006 (37)	Prospective cohort study	10 PA patients	4/6	42.5 ± 12.8	Infliximab	1	7	0	TC, HDLc.	4, 12, and 18 wks
Perez-Galan, 2006 (38)	Prospective cohort study	25 RA patients	8/17	52.4	Infliximab	NA	25	0	TC, HDLc, LDLc, TGs, AI	52 wks
Popa, 2007 (6)	Prospective cohort study	55 RA patients	16/40	56 ± 11	Infliximab	9	34	0	TC, HDLc, LDLc, TGs, AI	2, 24, and 52 wks
Tam, 2007 (39)	Prospective cohort study	19 RA patients	0/19	49 ± 10	Infliximab	1	19	0	TC, HDLc, LDLc, TGs, AI	2, 6, and 14 wks
Peters, 2007 (40)	Prospective cohort study	80 RA patients	NA	NA	Infliximab	35	77	4	HDLc	6, 22, and 48 wks
Komai, 2007 (41)	Prospective cohort study	15 RA patients	2/13	50 ± 3	Infliximab	NA	NA	NA	TC, HDLc, LDLc, TGs	2 and 6 wks
Soubrier, 2008 (42)	Prospective cohort study	29 RA patients	3/26	F (56 ± 10); M (70 ± 8)	Adalimumab (n = 12); infliximab (n = 11); etanercept (n = 6)	20	20	NA	TC, HDLc, LDLc, TGs, AI	14 wks
Garces, 2008 (43)	Prospective cohort study	65 patients: 30 RA, 29 AS, and 6 PA	29/36	47.4 ± 13.3	Infliximab (n = 44); etanercept (n = 21)	NA	NA	NA	TC, HDLc, LDLc, TGs, AI	52 wks
Bosello, 2008 (44)	Prospective cohort study	10 RA patients	1/9	53.10 ± 7.79	Infliximab	10	10	NA	TC, HDLc, TGs	2, 6, and 14 wks
Popa, 2009 (45)	Prospective cohort study	45 RA patients	14/31	56 ± 11	Infliximab	0	NA	0	TC, HDLc, LDLc, TGs, AI	2 and 24 wks
van Eijk, 2009 (46)	Prospective cohort study	92 AS patients	60/32	43 ± 11.2	Etanercept	NA	NA	7	TC, HDLc, LDLc, TGs	4 and 12 wks
Wijbrandts, 2009 (47)	Prospective cohort study	50 RA patients	12/38	51 ± 13	Adalimumab	16	50	6	TC, HDLc, TGs, AI	16 and 52 wks
Mathieu, 2010 (48)	Prospective cohort study	34 AS patients	24/10	43 ± 12	Infliximab (n = 20); etanercept (n = 7); adalimumab (n = 7)	1	7	NA	TC, HDLc, LDLc, TGs, AI	14 wks
Syngle, 2010 (49)	Prospective cohort study	12 AS patients	10/2	32.6 ± 3.94	Infliximab	0	NA	NA	TC, HDLc, LDLc, TGs, AI	12 wks
Jamnitski, 2010 (50)	Prospective cohort study	292 RA patients	54/238	52.8 ± 12.7	Etanercept	85	221	38	TC, HDLc	12 wks
Castro, 2011 (51)	Prospective cohort study	15 PA patients	8/7	41.9 ± 9.3	Infliximab, etanercept	7	0	0	TC, HDLc, LDLc, TGs	12 wks
Taguchi, 2012 (52)	Prospective cohort study	6 RA patients	NA	NA	Etanercept	NA	NA	NA	TC, TGs	52 wks
Mathieu, 2013 (53)	Prospective cohort study	49 AS patients	30/19	46.9 ± 12.1	Etanercept (n = 26); adalimumab (n = 17); infliximab (n = 6)	4	6	NA	TC, HDLc, LDLc, TGs, AI	24 and 52 wks
Sandoo, 2012 (54)	Prospective cohort study	23 RA patients	8/15	54 ± 15	Etanercept (n = 6); adalimumab (n = 15); infliximab (n = 2)	6	16	NA	TC, HDLc, TGs	2 and 12 wks
Di Minno, 2012 (17)	Prospective cohort study	48 PA patients	24/24	50.96 ± 9.86	Etanercept (n = 24); adalimumab (n = 18); infliximab (n = 6)	0	36	0	TC, HDLc, LDLc, TGs	52 wks
Di Minno, 2013 (46)	Prospective cohort study	270 PA patients	124/146	51.7 ± 11.4	Etanercept (n = 111); adalimumab (n = 80); infliximab (n = 79)	NA	111	NA	TC, HDLc, LDLc, TGs	52 wks
Iervolino, 2012 (56)	Prospective cohort study	136 PA patients	58/78	45.62 ± 11.82	Etanercept (n = 74); adalimumab (n = 46); infliximab (n = 16)	NA	50	NA	TC, TGs	12 wks

AI = atherogenic index; CCS = corticosteroids; HDLc = HDL-cholesterol; LDLc = LDL-cholesterol; mo = months; NA = not assessed; TC = total cholesterol; TGs = triglycerides; wks = weeks.

Figure 1. Studies on short-term changes in lipid levels in patients receiving TNF-α blockers.

Figure 2. Studies on middle-term changes in lipid levels in patients receiving TNF-α blockers.

Figure 3. Studies on long-term changes in lipid levels in patients receiving TNF-α blockers.

Table II. Subgroup analyses according to disease type (Panel A) and drug type (Panel B).

	Short-term			Middle-term			Long-term
PANEL A	Studies (n)	Patients (n)	Changes (mmol/L) [95% CI]	Studies (n)	Patients (n)	Changes (mmol/L) [95% CI]	Studies (n)	Patients (n)	Changes (mmol/L) [95% CI]
Rheumatoid arthritis
TC	13	659	0.25 [0.14, 0.36]	8	266	0.33 [0.05, 0.60]	6	214	0.22 [–0.19, 0.62]
HDLc	14	739	0.19 [0.09, 0.29]	9	346	0.11 [–0.04, 0.26]	6	288	0.12 [–0.12, 0.37]
LDLc	6	223	0.30 [0.09, 0.50]	5	198	0.07 [–0.13, 0.27]	5	202	0.05 [–0.22, 0.32]
TGs	9	266	0.19 [0.02, 0.37]	7	242	0.18 [–0.00, 0.37]	6	192	0.23 [–0.05, 0.51]
AI	6	252	0.04 [–0.13, 0.22]	6	232	0.04 [–0.18, 0.25]	4	156	–0.03 [–0.25, 0.18]
Psoriatic arthritis
TC	3	171	–0.02 [–0.23, 0.19]	1	10	0.10 [–0.78, 0.98]	2	318	–0.16 [–0.32, –0.00]
HDLc	3	25	–0.07 [–0.64, 0.50]	1	10	0.29 [–0.59, 1.17]	1	48	0.29 [–0.11, 0.69]
LDLc	1	15	0.05 [–0.66, 0.77]	–	–	–	1	16	0.20 [–0.37, 0.77]
TGs	2	161	0.00 [–0.23, 0.23]	–	–	–	2	318	0.10 [–0.05, 0.26]
AI	–	–	–	–	–	–	–	–	–
Ankylosing spondylitis
TC	3	104	–0.97 [–3.50, 1.55]	3	91	0.21 [–0.08, 0.49]	1	16	0.12 [–0.44, 0.69]
HDLc	3	130	0.33 [0.09, 0.58]	3	90	0.12 [–0.17, 0.40]	1	16	–0.30 [–0.87, 0.28]
LDLc	2	104	–0.16 [–0.70, 0.38]	2	65	0.21 [–0.12, 0.54]	1	48	0.18 [–0.22, 0.58]
TGs	1	12	–0.17 [–0.97, 0.63]	2	65	0.02 [–0.31, 0.34]	1	16	0.55 [–0.02, 1.13]
AI	1	12	–4.91 [–6.63, –3.20]	2	64	0.13 [–0.20, 0.46]	1	16	0.51 [–0.07, 1.09]
PANEL B
Infliximab
TC	11	366	0.19 [–0.07, 0.45]	5	189	0.16 [–0.04, 0.36]	4	164	0.26 [–0.31, 0.83]
HDLc	12	446	0.27 [0.14, 0.40]	6	269	0.05 [–0.12, 0.22]	5	244	0.10 [–0.20, 0.39]
LDLc	7	217	0.15 [–0.15, 0.44]	3	119	0.06 [–0.19, 0.32]	4	158	0.04 [–0.31, 0.40]
TGs	9	237	0.23 [0.05, 0.41]	4	129	0.38 [0.13, 0.63]	4	142	0.33 [0.02, 0.65]
AI	6	256	–0.25 [–0.75, 0.26]	3	119	0.26 [0.01, 0.52]	3	112	0.02 [–0.24, 0.27]
Adalimumab
TC	2	41	0.29 [–0.14, 0.73]	1	50	0.18 [–0.21, 0.57]	1	44	0.11 [–0.30, 0.51]
HDLc	2	41	0.42 [–0.02, 0.86]	1	50	0.37 [–0.03, 0.76]	1	44	0.26 [–0.15, 0.66]
LDLc	1	233	0.11 [–0.37, 0.60]	1	50	0.08 [–0.31, 0.47]	1	44	0.05 [–0.35, 0.46]
TGs	1	33	–0.12 [–0.60, 0.36]	1	50	–0.04 [–0.43, 0.35]	1	44	–0.15 [–0.55, 0.26]
AI	1	8	–0.46 [–1.46, 0.53]	1	50	–0.20 [–0.59, 0.19]	1	44	–0.16 [–0.56, 0.25]
Etanercept
TC	2	384	0.16 [0.01, 0.30]	–	–	–	1	6	0.06 [–1.07, 1.20]
HDLc	2	384	0.14 [–0.10, 0.39]	–	–	–	–	–	–
LDLc	1	92	0.01 [–0.28, 0.30]	–	–	–	–	–	–
TGs	–	–	–	–	–	–	1	6	0.25 [–0.89, 1.38]
AI	–	–	–	–	–	–	–	–	–

AI = atherogenic index; HDLc = HDL-cholesterol; LDLc = LDL-cholesterol; TC = total cholesterol; TGs = triglycerides.

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