Cholesterol levels increase after corticosteroid, tofacitinib use in IBD
Corticosteroid and tofacitinib use in patients with inflammatory bowel disease correlated with increased total cholesterol levels, according to research published in Alimentary Pharmacology and Therapeutics.
“Patients with an active chronic inflammatory disease have lower levels of total cholesterol, HDL-cholesterol (HDL-c) and LDL-cholesterol (LDL-c) compared with patients who are in disease remission and the general population. This so-called “lipid paradox” has been mirrored in other inflammatory states,” Jasmijn A.M. Sleutjes, MD, Erasmus Medical Center, and colleagues wrote. “The severity of the underlying inflammation is associated with the magnitude of these lipid changes. Randomized controlled trials and observational studies in patients with IBD demonstrated increases in lipid levels after therapy initiation. ... It is unknown if lipid levels are affected similarly by all classes of IBD therapy.”
To assess the effect of different IBD drug classes on lipid profile, researchers performed a systematic review of 11 studies comprising 1,663 patients with IBD (15% Crohn’s disease, 85% ulcerative colitis) that assessed lipid levels before induction and after induction as well as through maintenance treatment.
According to study results, researchers observed a change in total cholesterol levels after induction therapy among patients dosed with corticosteroids (mean change, +1.19 mmol/L; 95% CI, 0.52-2.59), tofacitinib (mean change, +0.66 mmol/L; 95% CI, 0.42-0.79) and filgotinib (Gilead Sciences/Galapagos NV; mean change, +0.39 mmol/L). Investigators saw similar trends following maintenance therapy (corticosteroid mean change, +1.33 mmol/L; 95% CI, 0.28-2.26; tofacitinib mean change, +0.55 mmol/L; 95% CI, 0.43-0.68; filgotinib mean change, +0.28 mmol/L). Conversely, anti-tumor necrosis factor agents were not associated with changes to total cholesterol levels after induction therapy (mean change, –0.11 mmol/L; 95% CI, –0.26-0.36) or maintenance therapy (mean change, 0.08 mmol/L; 95% CI, –0.07-0.39).
“We demonstrated significant and persistent lipid changes in IBD patients starting corticosteroids and tofacitinib independent of treatment regimens. In addition, tofacitinib increased HDL-c and LDL-c and reduced triglyceride levels significantly both after induction and maintenance therapy,” Sleutjes concluded. “The effect of anti-TNF-a agents on total cholesterol changes was neutral.”