Anti-tumor necrosis factor-alpha therapy significantly improved HDL cholesterol levels and microvascular endothelial-dependent function in patients with rheumatoid arthritis for a short period before waning in a recent study.
Researchers conducted a longitudinal study on 23 patients with rheumatoid arthritis (RA) to evaluate the effect of anti-tumor necrosis factor-alpha (anti-TNF-a) on HDL cholesterol levels and microvascular and macrovascular endothelial function. Fifteen patients were administered 40 mg adalimumab biweekly, six took 50 mg etanercept weekly and two received 3 mg/kg infliximab. All patients were followed up at 2 weeks and 3 months before receiving additional therapy.
As investigators anticipated, disease activity markers for C-reactive protein (10 mg/L vs. 5 mg/L), fibrinogen (5.1 ± 1.0 g/L vs. 4.3 ± 0.91 g/L) and Disease Activity Score 28 (4.22 ± 0.94 vs. 2.80 ± 1.30) showed significant reduction (all P<.001) from baseline to 3-month follow-up for all treated patients. HDL cholesterol improved in 2 weeks (1.4 ± 0.3 mmol/L vs. 1.5 ± 0.3 mmol/L; P<.05) before declining to baseline level at 3 months (P=.014 overall). This improvement also was observed in microvascular endothelial function for acetylcholine-mediated dilatation from baseline to 2 weeks (319 ± 217% vs. 437 ± 247%; P=.001) and then decreased at 3 months (348 ± 209%; P=.017 overall). There were no significant changes in macrovascular endothelial function across the study period.
“The present study revealed that treatment with anti-TNF-a resulted in a transient improvement in HDL cholesterol levels and a concomitant improvement in microvascular but not in macrovascular endothelial function,” the researchers concluded. “This was possibly mediated by a favorable effect of HDL cholesterol on microvascular endothelial function. Further prospective studies utilizing larger sample sizes are required.”