According to a recent retrospective study by researchers at the Brigham and Women’s Hospital, Boston, in patients with early rheumatoid arthritis (RA), treatment with antimalarial hydroxychloroquine may reduce the risk of hyperlipidemia, when compared with methotrexate (MTX). Findings from the study published in the Journal Arthritis Care & Research also provided results concerning the fact that disease-modifying anti rheumatic drug (DMARD) may possibly increase hyperlipidemia risk in some patients initiating treatment with tumor necrosis factor alpha (TNF alpha inhibitors).
Patients with RA are at higher risk of cardiovascular disease (CVD), however, evidence has indicated that patients with RA may have lower total and low-density lipoprotein (LDL) cholesterol compared to people without RA. “Reports of inverse association between inflammatory markers and lipid parameters may explain this phenomenon,” Desai and associates wrote.
In the study entitled “Disease-Modifying Antirheumatic Drug Use and the Risk of Incident Hyperlipidemia in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study,” Rishi J. Desai, PhD, a postdoctoral research fellow in the hospital’s Division of Pharmacoepidemiology and Pharmacoeconomics, along with colleagues compared the risk of incident hyperlipidemia in early rheumatoid arthritis (RA) patients after initiation of various disease-modifying anti rheumatic drugs (DMARDs).
The researchers conducted a cohort study using insurance claims data from 2001 to 2012 in patients with early RA. This was defined by the absence of any RA diagnosis or DMARD prescriptions for the past 12 months. Four groups were demarcated based on the initiation of DMARD: tumor necrosis factor α (TNFα) inhibitors ± nonbiologic (nb) DMARDs, methotrexate (MTX) ± nonhydroxycholorquine nbDMARDs, hydroxychloroquine ± non-MTX nbDMARDs, and other nbDMARDs only.
The primary outcome was incident hyperlipidemia, defined by a diagnosis and a prescription for a lipid-lowering agent. For the subgroup of patients with laboratory results available, change in lipid levels was assessed.
Excluding those diagnosed with hyperlipidemia, or CVDs, or prescribed lipid-lowering drugs, the researchers identified a total of 17,145 eligible patients with early RA patients. The results revealed that that of the total sample, 364 developed incident hyperlipidemia.
Compared with MTX, in the full cohort the adjusted hazard ratios for hyperlipidemia were 1.41 for TNF alpha inhibitors; 0.81 for hydroxychloroquine; and 1.33 for other nonbiologic DMARDs. HRs for the propensity score-trimmed cohort were 1.18, 0.75, and 1.41, respectively.
In the subgroup analysis, the use of hydroxychloroquine revealed reductions in lipids from baseline compared with MTX. For LDL cholesterol the decrease was -8.9 mg/dL; for total cholesterol it was -12.3 mg/dL; and for triglycerides it was -19.5 mg/dL.
Results from the primary analysis showed an increased risk for hyperlipidemia in those patients starting treatment with anti-TNF alpha versus MTX, however this association was mitigated in the analysis stratifying by propensity score (PS), where TNF alpha inhibition was not associated with an increase in the risk.
“The discrepancy in the effect of TNF alpha inhibitors on the risk of hyperlipidemia between the full cohort and the PS trimmed cohort deserves discussion,” the authors wrote according to the news release.
The researchers concluded that initiation of hydroxychloroquine might be associated with a lower risk of incident hyperlipidemia among patients with early RA compared with MTX initiation. However, more research is necessary to evaluate the effect of TNF inhibitors on the risk of hyperlipidemia.