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Beneficial effect of 1-year etanercept treatment on the lipid profile in responding patients with rheumatoid arthritis: the ETRA study
  1. A Jamnitski1,
  2. I M Visman1,
  3. M J L Peters2,
  4. B A C Dijkmans1,2,
  5. A E Voskuyl2,
  6. M T Nurmohamed1,2
  1. 1Jan van Breemen Institute, Amsterdam, The Netherlands
  2. 2VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr M T Nurmohamed, Department of Rheumatology, Jan van Breemen Institute, Dr Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands; m.nurmohamed{at}


Background Effective anti-inflammatory treatment with tumour necrosis factor α (TNFα) inhibitors may have favourable effects on the lipid profile. Available evidence is derived from short-term studies, and it is not clear whether TNFα inhibitors have a similar effect on the lipid profile in responders and non-responders to the treatment.

Objectives To investigate the effect of long-term etanercept treatment on the lipid profile in a large sample of patients with rheumatoid arthritis (RA), stratified for European League Against Rheumatism (EULAR) response.

Methods Between 2004 and 2008, 292 consecutive patients with active RA (DAS28 >3.2) and a new etanercept prescription were included in an observational cohort. Clinical response variables and lipid samples were collected at baseline and after 4 months and 1 year of etanercept treatment. Generalised estimating equation analyses were used to investigate the longitudinal course of lipid levels in relation to clinical response variables.

Results According to the EULAR response criteria, 76% of the patients were good or moderate responders at 4 months, and 85% of the remainder at 1 year. Significant changes in apoA-I (increased by 3.5% (p=0.002) at 4 months and 3.1% (p=0.005) at 1 year) and apoB/apoA-I ratio (decreased by 6.2% (p<0.001) at 4 months and 3.6% (p=0.025) at 1 year) were observed in EULAR responders. No significant differences were observed in EULAR non-responders at all time points.

Conclusions Treatment with etanercept resulted in a significant and sustained decrease in the apoB/apoA-I ratio in patients with good or moderate EULAR response. This may have a beneficial effect on the cardiovascular risk in patients with RA.

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  • Funding The clinical part of this study was partially financed by Wyeth Pharmaceuticals. In addition, this investigation was facilitated by the Clinical Research Bureau of the Jan van Breemen Institute. The study sponsors had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Medical Ethics Committee of the Slotervaart Hospital, BovenIJ Hospital, the Jan van Breemen Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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    BMJ Publishing Group Ltd and European League Against Rheumatism