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Changes in lipid profile during infliximab treatment and corticosteroid therapy in rheumatoid arthritis
  1. M JL Peters (m.peters{at}janvanbreemen.nl)
  1. VU University Medical Center, Netherlands
    1. M Vis (m.vis{at}vumc.nl)
    1. VU University Medical Center, Netherlands
      1. V P van Halm (v.halm{at}chello.nl)
      1. VU University Medical Center, Netherlands
        1. G J Wolbink (g.wolbink{at}janvanbreemen.nl)
        1. Jan van Breemen Institute, Netherlands
          1. A E Voskuyl (ae.voskuyl{at}vumc.nl)
          1. VU University Medical Center, Netherlands
            1. W F Lems (wf.lems{at}vumc.nl)
            1. VU University Medical Center, Netherlands
              1. B AC Dijkmans (bac.dijkmans{at}vumc.nl)
              1. VU University Medical Center, Netherlands
                1. J WR Twisk (jwr.twisk{at}vumc.nl)
                1. VU University Medical Center, Netherlands
                  1. M HMT de Koning (m.d.koning{at}janvanbreemen.nl)
                  1. Jan van Breemen Institute, Netherlands
                    1. R J van de Stadt (r.vd.stadt{at}janvanbreemen.nl)
                    1. Jan van Breemen Institute, Netherlands
                      1. M T Nurmohamed (m.nurmohamed{at}janvanbreemen.nl)
                      1. Jan van Breemen Institute, Netherlands

                        Abstract

                        Objectives:To evaluate the effects of infliximab and corticosteroid therapy on the lipid profile in patients with active rheumatoid arthritis (RA).

                        Methods:Infliximab infusions were given at week 0, 2, 6 and then every 8 weeks. Prior to each infusion, disease activity parameters (DAS-28, CRP) and lipid levels (total-, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A-1 (Apo A-1) and apolipoprotein B) were measured in 80 consecutive RA patients, who completed the study period of 48 weeks. Longitudinal analyses were used to investigate [1] the course of lipid levels over a period of time and [2] the relationship between lipids, prednisone dose and disease activity.

                        Results:Infliximab treatment causes a significant reduction in disease activity and a concomitant decrease of prednisone dose. Although they initially improved significantly, all lipid levels had returned to baseline levels after 48 weeks, except for Apo A-1. Longitudinal analyses reveal significant yet opposite associations between lipid levels and disease activity and between lipid levels and prednisone dose. DAS-28 improvement by 1 point is associated with an increase of 0.016 mmol/l (0.618 mg/dl) total- and 0.045 mmol/l (1.737 mg/dl) HDL cholesterol. Reduction of 10 mg prednisone is associated with a decrease of 0.04 mmol/l (1.544 mg/dl) total- and 0.16 mmol/l (6.177 mg/dl) HDL cholesterol.

                        Conclusion:Overall, no changes in serum lipid levels were observed after 48 weeks of infliximab treatment. The initial beneficial effects of infliximab on the lipid profile, by means of a reduction of disease activity, are attenuated by a concomitant decrease in prednisone dose.

                        • disease activity
                        • immunosuppressive treatment
                        • lipid profile
                        • rheumatoid arthritis

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