类风湿关节炎患者致动脉粥样硬化的四年随访：来自全国韩国风湿病学会生物制剂注册中心。

Four-year follow-up of atherogenicity in rheumatoid arthritis patients: from the nationwide Korean College of Rheumatology Biologics Registry.

机构信息

Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea.

Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.

出版信息

Clin Rheumatol. 2021 Aug;40(8):3105-3113. doi: 10.1007/s10067-021-05613-x. Epub 2021 Feb 12.

DOI:10.1007/s10067-021-05613-x

PMID:33576925

Abstract

OBJECTIVE

This study aimed to evaluate the impact of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) on lipid profile and atherogenic index of plasma (AIP) in rheumatoid arthritis (RA) patients and to compare the occurrence of dyslipidemia between patients using bDMARDs, tsDMARDs, or conventional DMARDs (cDMARDs).

METHODS

Data on lipid profile, AIP, and occurrence of dyslipidemia were collected from the Korean College of Rheumatology BIOlogics registry. A comparison was conducted between patients using bDMARDs (tumor necrosis factor (TNF)-α inhibitor, tocilizumab, abatacept), Janus kinase inhibitors (JAKis), and cDMARDs. The Kaplan-Meier method was used to compare the occurrence of dyslipidemia between groups, and hazard ratios (HR) were calculated using the cox proportional hazard method.

RESULTS

The data of 917, 826, 789, 691, and 520 RA patients were eligible for analysis at the baseline, 1-year, 2-year, 3-year, and 4-year follow-ups, respectively. Baseline total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were higher in the cDMARDs group, whereas AIP was comparable. During the 4-year follow-up, AIP was comparable between the groups. The occurrence of dyslipidemia did not show a significant difference when comparing the bDMARDs/tsDMARDs and cDMARDs groups (P=0.06) or the TNF-α inhibitor, tocilizumab, abatacept, JAKi, and cDMARD user groups (P=0.3). In the multivariate cox proportional hazard model, older age (HR=1.03, P=0.005) and concomitant hypertension (HR=2.21, P=0.013) were significantly associated with dyslipidemia occurrence.

CONCLUSION

Long-term use of bDMARDs and tsDMARDs is relatively safe with regard to lipid profile, AIP, and the occurrence of dyslipidemia in RA patients. Key Points • The use of bDMARDs and tsDMARDs did not increase the risk of dyslipidemia than cDMARDs use in patients with RA. • AIP was comparable between bDMARDs user, tsDMARDs user, and cDMARDs user group in 4-year follow-up data. • Based on the present study, the long-term use of bDMARDs or tsDMARDs did not significantly deteriorate atherogenic lipid profile nor an increased risk of dyslipidemia in patients with RA.

摘要

目的

本研究旨在评估生物改善病情抗风湿药物（bDMARDs）和靶向合成改善病情抗风湿药物（tsDMARDs）对类风湿关节炎（RA）患者血脂谱和血浆致动脉粥样硬化指数（AIP）的影响，并比较使用 bDMARDs、tsDMARDs 或传统改善病情抗风湿药物（cDMARDs）的患者发生血脂异常的情况。

方法

从韩国风湿病学会 BIOlogics 登记处收集血脂谱、AIP 和血脂异常发生的数据。比较使用 bDMARDs（肿瘤坏死因子（TNF）-α抑制剂、托珠单抗、阿巴西普）、Janus 激酶抑制剂（JAKi）和 cDMARDs 的患者。使用 Kaplan-Meier 方法比较各组血脂异常的发生情况，并使用 cox 比例风险法计算危险比（HR）。

结果

在基线、1 年、2 年、3 年和 4 年随访时，分别有 917、826、789、691 和 520 例 RA 患者符合纳入标准。基线总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和甘油三酯（TG）在 cDMARDs 组较高，而 AIP 相似。在 4 年随访期间，各组之间的 AIP 相似。与 cDMARDs 组相比，bDMARDs/tsDMARDs 组和 TNF-α抑制剂、托珠单抗、阿巴西普、JAKi 和 cDMARDs 使用者组的血脂异常发生率无显著差异（P=0.06）。在多变量 cox 比例风险模型中，年龄较大（HR=1.03，P=0.005）和合并高血压（HR=2.21，P=0.013）与血脂异常的发生显著相关。