类风湿关节炎治疗策略对血脂和血管炎症的影响：靶向随机活性对照试验的二次分析。
Impact of RA treatment strategies on lipids and vascular inflammation in rheumatoid arthritis: a secondary analysis of the TARGET randomized active comparator trial.
机构信息
Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
出版信息
Arthritis Res Ther. 2024 Jun 24;26(1):123. doi: 10.1186/s13075-024-03352-3.
BACKGROUND
Treatments for rheumatoid arthritis (RA) are associated with complex changes in lipids and lipoproteins that may impact cardiovascular (CV) risk. The objective of this study was to examine lipid and lipoprotein changes associated with two common RA treatment strategies, triple therapy or tumor necrosis factor inhibitor (TNFi), and association with CV risk.
METHODS
In this secondary data analysis of the TARGET trial, methotrexate (MTX) inadequate responders with RA were randomized to either add sulfasalazine and hydroxychloroquine (triple therapy), or TNFi for 24-weeks. The primary trial outcome was the change in arterial inflammation measured in the carotid arteries or aorta by FDG-PET/CT at baseline and 24-weeks; this change was described as the target-to-background ratio (TBR) in the most diseased segment (MDS). Routine lipids and advanced lipoproteins were measured at baseline and 24-weeks; subjects on statin therapy at baseline were excluded. Comparisons between baseline and follow-up lipid measurements were performed within and across treatment arms, as well as change in lipids and change in MDS-TBR.
RESULTS
We studied 122 participants, 61 in each treatment arm, with median age 57 years, 76% female, and 1.5 year median RA disease duration. When comparing treatment arms, triple therapy had on average a larger reduction in triglycerides (15.9 mg/dL, p = 0.01), total cholesterol to HDL-C ratio (0.29, p-value = 0.01), and LDL particle number (111.2, p = 0.02) compared to TNFi. TNFi had on average a larger increase in HDL particle number (1.6umol/L, p = 0.006). We observed no correlation between change in lipid measurements and change in MDS-TBR within and across treatment arms.
CONCLUSIONS
Both treatment strategies were associated with improved lipid profiles via changes in different lipids and lipoproteins. These effects had no correlation with change in CV risk as measured by vascular inflammation by FDG-PET/CT.
TRIAL REGISTRATION
ClinicalTrials.gov ID NCT02374021.
背景
类风湿关节炎 (RA) 的治疗会引起复杂的血脂和脂蛋白变化，可能会影响心血管 (CV) 风险。本研究的目的是探讨两种常见的 RA 治疗策略（三联疗法或肿瘤坏死因子抑制剂 [TNFi]）相关的血脂和脂蛋白变化，以及与 CV 风险的关联。
方法
在 TARGET 试验的二次数据分析中，将 MTX 应答不足的 RA 患者随机分为加用柳氮磺胺吡啶和羟氯喹（三联疗法）或 TNFi 治疗 24 周。主要试验结局是基线和 24 周时 FDG-PET/CT 测量的颈动脉或主动脉的动脉炎症变化，该变化以最严重节段 (MDS)的靶标与背景比 (TBR) 表示。在基线和 24 周时测量常规血脂和先进的脂蛋白；在基线时服用他汀类药物的患者被排除在外。在治疗臂内和臂间以及血脂变化和 MDS-TBR 变化方面，比较了基线和随访时的血脂测量值。
结果
我们研究了 122 名参与者，每组 61 名，中位年龄 57 岁，76%为女性，RA 病程中位数为 1.5 年。与 TNFi 相比，三联疗法平均降低甘油三酯（15.9mg/dL，p=0.01）、总胆固醇与高密度脂蛋白胆固醇比值（0.29，p 值=0.01）和 LDL 颗粒数（111.2，p=0.02）。TNFi 平均增加高密度脂蛋白颗粒数（1.6umol/L，p=0.006）。我们没有观察到治疗臂内和臂间的血脂测量值变化与 MDS-TBR 变化之间存在相关性。
结论
两种治疗策略都通过改变不同的脂质和脂蛋白来改善血脂谱。这些作用与 FDG-PET/CT 测量的血管炎症的 CV 风险变化无关。
试验注册
ClinicalTrials.gov ID NCT02374021。
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