The effects of rituximab on the lipid profile of patients with active systemic lupus erythematosus: results from a nationwide cohort in Spain (LESIMAB).
BACKGROUND
Patients with systemic lupus erythematosus (SLE) have increased cardiovascular risk related to lipid changes induced by inflammatory activity, proteinuria and treatments. Our objective was to analyse lipid changes in a cohort of patients with SLE resistant to standard treatments who were treated with rituximab.


METHODS
The study population comprised a retrospective multicentre, national cohort of patients with SLE resistant to standard treatments who were treated with rituximab. The basic lipid profile, concomitant treatment and disease activity were analysed at the start of the treatment, 24 weeks later, and at the end of the follow-up period. The effects of the main lupus variables and therapy on the lipid changes were analysed.


RESULTS
Seventy-nine patients with active lupus treated with rituximab were assessed during 149.3 patient-years. Prior to the treatment, 69% had dyslipidaemia. The most frequent abnormalities were a low-density lipoprotein (LDL) level of ≥100 mg/dl (34%) and a high-density lipoprotein (HDL) level of <50 mg/dl (27%). Baseline total cholesterol (TC) and LDL levels correlated with the degree of proteinuria, while the concentration of triglycerides (TGs) correlated with the SLE Disease Activity Index (SLEDAI). TGs were reduced at short- and long-term follow-up after rituximab treatment. A multiple linear regression analysis identified that the reduction of the lupus inflammatory activity, particularly changes in proteinuria, was the only independent variable that was positively associated with the reduction in TGs after 24 weeks (p=0.001) and with TC (p=0.005) and TGs (p<0.001) at the end of the follow-up period.


CONCLUSIONS
Our results suggest that rituximab may improve the long-term lipid profile of patients with SLE refractory to standard treatment, mainly by reducing inflammatory activity.
UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain.
A
A
Fernández-Nebro
Hospital Virgen de Valme, Rheumatology Department, Sevilla, Spain.
J L
JL
Marenco
Hospital General Universitario Gregorio Marañón, Rheumatology Department, Madrid, Spain.
F
F
López-Longo
Hospital Universitario 12 de Octubre, Rheumatology Department, Madrid, Spain.
M
M
Galindo
Hospital Virgen Macarena, Rheumatology Department, Sevilla, Spain.
B E
BE
Hernández-Cruz
Hospital Universitario de Bellvitge, Rheumatology Department, Hospitalet de Llobregat, Barcelona, Spain.
J
J
Narváez
Hospital Universitario de Gran Canaria Dr Negrín, Rheumatology Department, Las Palmas de Gran Canaria, Spain.
I
I
Rúa-Figueroa
Hospital Clínico Universitario San Cecilio, Rheumatology Department, Granada, Spain.
E
E
Raya-Alvarez
Hospital Universitario Ramón y Cajal, Rheumatology Department, Madrid, Spain.
A
A
Zea
Complejo Hospitalario Universitario A Coruña, Rheumatology Department, A Coruña, Spain.
M
M
Freire
Hospital Universitario Príncipe de Asturias, Rheumatology Department, Alcalá de Henares, Madrid, Spain.
A I
AI
Sánchez-Atrio
Hospital Universitario de la Princesa, Rheumatology Department, Madrid, Spain.
R
R
García-Vicuña
Complejo Hospitalario Universitario de Vigo, Rheumatology Department, Hospital del Mexoeiro, Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain.
J M
JM
Pego-Reigosa
UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain sarama_82@hotmail.com.
S
S
Manrique-Arija
UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain.
L
L
Nieves-Martín
Hospital General Universitario Gregorio Marañón, Rheumatology Department, Madrid, Spain.
L
L
Carreño
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008055:Lipids / Q000097:blood*; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D008055:Lipids; D000069283:Rituximab
Systemic lupus erythematosus; cohort; lipid profile; proteinuria; refractory; rituximab