TNF-alpha inhibitors temporarily increased high-density lipoprotein (HDL) cholesterol levels in patients with psoriasis. The changes, however, were not consistent across treatment duration or drug type.
These findings come from a recent systematic review and meta-analysis that appears in .
Four TNF-alpha inhibitors -- infliximab, etanercept, adalimumab, and certolizumab -- were included in the study. Researchers performed subgroup analyses according to the type of TNF-alpha inhibitor and treatment duration, among other factors.
A total of 20 trials were included in the analysis. Top-line findings revealed that TNF-alpha inhibitors elevated HDL levels in people with psoriasis (WMD=2.31; 95% CI 0.96-3.67; P=0.001). Levels were most significantly increased among patients who had been receiving TNF-alpha inhibitors for 3 months or less (WMD=2.88; 95% CI 1.37-4.4; P<0.001), as well as patients taking etanercept (WMD=3.4; 95% CI 1.71-5.09, P<0.001).
Triglyceride levels increased significantly in the 3-6 month group (WMD=4.98; 95% CI 1.97-7.99, P=0.001) and decreased significantly beginning at the 6-month mark (WMD= -19.84; 95% CI -23.97 to -15.7, P<0.001).
Excerpts from the study, which was led by researchers in China, have been edited for length and clarity.
What sparked this investigation?
The introduction of biologics has greatly expanded treatment options for patients with moderate-to-severe psoriasis. Among these biologics, TNF-alpha inhibitors have been used for more than a decade and have dramatically improved clinical outcomes.
TNF-alpha inhibitors have been reported to possibly affect lipid metabolism. However, there is currently no consensus on the effect of TNF-alpha inhibitors on lipid profiles in people with psoriasis. This analysis aimed to address that gap.
What were the key findings?
Overall findings revealed that TNF-alpha inhibitors elevated HDL levels in patients with psoriasis. This finding persisted following sensitivity analyses that excluded the effects of lipid-lowering drugs.
HDL levels were significantly increased among those who received TNF-alpha inhibitors for 3 months or less. Changes in triglyceride levels were not consistent among the different durations of treatment. Specifically, triglycerides were significantly increased in the 3-6 month group and significantly decreased in those taking TNF-alpha inhibitors for 6 months or longer.
Does this mean that TNF-alpha inhibitors have a protective effect in people with psoriasis?
The increase in HDL levels may represent a cardioprotective effect. However, previous meta-analysis found no significant differences in the rate of major adverse cardiovascular events between psoriasis patients who were treated with TNF-alpha inhibitors and those who received placebo.
Thus, the increase of HDL levels observed in the current meta-analysis may be limited.
What is the clinical take-away for dermatologists?
Findings emphasized the importance of lipid screenings when treating psoriasis patients with TNF-alpha inhibitors.
No investigator in this study disclosed any relevant financial relationships with industry.
Primary Source
Frontiers in Immunology
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