Background Plasma concentrations of lipoprotein (a) [Lp(a)], a lipoprotein with proatherogenic and thrombogenic properties, have a strong genetic basis, although high concentrations of Lp(a) have also been reported in the context of inflammation, as rheumatoid arthritis (RA) (1). There are few studies that evaluate the impact of biologic therapies on Lp(a) in RA (2), taking into account that with these new therapies a better control of inflammation is achieved.
Objectives Evaluate the plasma concentrations of Lp(a) in Spanish RA patients on biologics therapy attending rheumatology outpatient clinics.
Methods Baseline analysis of the CARMA project (CARdiovascular in rheuMAtology), a 10-year prospective study evaluating the risk of cardiovascular events in RA patients and other forms of inflammatory arthritis who attended rheumatology outpatient clinics at 67 hospitals in Spain. RA patients were classified into four categories: no biologic therapy, undergoing anti-TNF therapy, receiving anti-IL-6 receptor tocilizumab (TCZ), and other biologic therapies (rituximab or abatacept). A model of linear multivariate regression was built in which the dependent variable was Lp(a) concentration and the explanatory variable was biologic therapy. The model was adjusted for confounding factors.
Results Seven hundred and seventy-five RA patients were analyzed. Total cholesterol and triglycerides concentrations were significantly higher in TCZ-treated patients. Nevertheless, no significant difference in the atherogenic index (TC/HDL-c) between TCZ-treated patients and patients without biological therapy was found. After adjusting for confounding factors, patients treated with biologic therapy had lower plasma concentrations of Lp(a) than those not undergoing biologic therapy. However, only TCZ-treated patients achieved statistically significant differences when compared with those not undergoing biologic therapy (β-coefficient: -0.303, 95% confidence interval: -0.558 to -0.047; p=0.02).
Conclusions RA patients treated with tocilizumab, an inhibitor of interleukin 6 receptor, show lower plasma concentrations of Lp (a) compared to patients without biological therapy.
Garcia-Gomez C et al. J Rheumatol 2009, 36:1365–1370.
McInnes IB et al. Ann Rheum Dis 2015, 74:694–702.
Disclosure of Interest None declared