title: The effect of TNF-alpha blocking therapy on lipid levels in rheumatoid arthritis: a meta-analysis.
abstract: OBJECTIVE
  Changes in the lipid profile have been described in patients with rheumatoid arthritis (RA) following therapy with tumor necrosis factor (TNF)-alpha blocking agents. However, thus far, results have been inconsistent. Therefore, we investigated changes in lipid levels after TNF-alpha blocking therapy using meta-analysis of published data.
  
  
  METHODS
  The literature was searched to identify studies assessing changes in total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol, triglycerides, atherogenic index (ie, TC/HDLc ratio), and apolipoprotein levels in response to TNF-alpha blocking therapy. Weighted mean levels of lipids at different time points and subsequent changes in these lipid levels between these time points were calculated with multivariate linear mixed models.
  
  
  RESULTS
  Data were available on TC in 15 studies encompassing 766 RA patients and on HDLc in 14 studies encompassing 736 RA patients. TC increased significantly (maximum increase of 10%) and HDLc increased significantly in the first 2 to 6 weeks of therapy (maximum increase of 7%), after which it remained more or less stable. The atherogenic index did not significantly change over time. There was too limited information to evaluate changes in other lipids and apolipoproteins.
  
  
  CONCLUSIONS
  TNF-alpha blocking therapy has a modest effect on TC and HDLc levels in RA patients with no significant overall effect on the atherogenic index. Whether TNF-alpha blocking effects on qualitative lipid changes (structure and function) are more relevant to their presumed vascular benefits requires further study.
authors.affiliation: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Alper M
authors.initials: AM
authors.lastname: van Sijl
authors.forename: Mike J L
authors.initials: MJ
authors.lastname: Peters
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Riekie H C
authors.initials: RH
authors.lastname: de Vet
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Ben A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: Yvo M
authors.initials: YM
authors.lastname: Smulders
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008055:Lipids / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D008055:Lipids; D014409:Tumor Necrosis Factor-alpha