Effects of tofacitinib and other DMARDs on lipid profiles in rheumatoid arthritis: implications for the rheumatologist

https://doi.org/10.1016/j.semarthrit.2016.03.004Get rights and content
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Abstract

Cardiovascular (CV) morbidity and mortality are increased in patients with active, untreated rheumatoid arthritis (RA), despite lower levels of total and low-density lipoprotein cholesterol reported in individuals with active RA compared with those without RA. Alterations in non-traditional lipid assessments, such as high-density lipoprotein (HDL) function and HDL-associated proteins, have been described in patients with active RA, including elevated HDL-associated serum amyloid A and decreased paraoxonase-1 activity. We review changes in both traditional lipoprotein concentrations and non-traditional lipoprotein assessments in multiple studies of treatment with disease-modifying antirheumatic drugs (DMARDs), including non-biologic and biologic DMARDs and tofacitinib. In addition, data from a recently published clinical trial with tofacitinib that describe a potential mechanism for suppression of cholesterol levels in active RA patients are reviewed. Finally, CV event data from various studies of DMARDs are presented, and the current management of RA patients with regard to the CV risk is reviewed.

Abbreviations

Apo
apolipoprotein
BID
twice daily
CV
cardiovascular
CVD
cardiovascular disease
CE
cholesterol ester
CETP
cholesterol ester transfer protein
CRP
C-reactive protein
DAS28
Disease Activity Score with 28 joint-count
DMARD
disease-modifying antirheumatic drug
EULAR
European League Against Rheumatism
FC
free cholesterol
FCR
fractional catabolic rate
HDL
high-density lipoprotein
HDL-C
high-density lipoprotein cholesterol
JAK
Janus kinase
LCAT
lecithin–cholesterol acyltransferase
LDL
low-density lipoprotein
LDL-C
low-density lipoprotein cholesterol
LTE
long-term extension
MACE
major adverse cardiovascular event
MPO
myeloperoxidase
MTX
methotrexate
PON-1
paraoxonase-1
RA
rheumatoid arthritis
SAA
serum amyloid A
TC
total cholesterol
TCZ
tocilizumab
TG
triglyceride
TNF
tumor necrosis factor

Keywords

Disease-modifying antirheumatic drugs
Janus kinase
Rheumatoid arthritis
TNF inhibitors
Tofacitinib

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