背景:类风湿性关节炎(RA)的治疗与可能影响心血管(CV)风险的脂质和脂蛋白的复杂变化有关。这项研究的目的是检查与两种常见RA治疗策略相关的脂质和脂蛋白变化,三联疗法或肿瘤坏死因子抑制剂(TNFi),以及与CV风险的关联。
方法:在TARGET试验的次要数据分析中,甲氨蝶呤(MTX)治疗RA的反应不充分者被随机分为柳氮磺吡啶和羟氯喹(三联疗法),或TNFi24周。主要试验结果是在基线和24周时通过FDG-PET/CT在颈动脉或主动脉中测量的动脉炎症的变化;这种变化被描述为大多数病变段(MDS)中的目标背景比(TBR)。在基线和24周测量常规脂质和晚期脂蛋白;排除基线时接受他汀类药物治疗的受试者。基线和随访脂质测量值之间的比较在治疗组内和治疗组之间进行。以及脂质的变化和MDS-TBR的变化。
结果:我们研究了122名参与者,61在每个治疗臂,平均年龄57岁,76%为女性,和1.5年中位RA病程。当比较治疗手臂时,三联疗法平均降低甘油三酯(15.9mg/dL,p=0.01),总胆固醇与HDL-C的比值(0.29,p值=0.01),和与TNFi相比的LDL颗粒数(111.2,p=0.02)。TNFi的HDL颗粒数平均增加较大(1.6umol/L,p=0.006)。我们观察到脂质测量值的变化与治疗组内和治疗组间MDS-TBR的变化之间没有相关性。
结论:两种治疗策略均通过改变不同的脂质和脂蛋白与改善的血脂谱相关。这些影响与通过FDG-PET/CT的血管炎症测量的CV风险的变化无关。
背景:ClinicalTrials.govIDNCT02374021。
BACKGROUND: Treatments for rheumatoid arthritis (RA) are associated with complex changes in lipids and lipoproteins that may impact cardiovascular (CV) risk. The objective of this
study was to examine lipid and lipoprotein changes associated with two common RA treatment strategies, triple therapy or tumor necrosis factor inhibitor (TNFi), and association with CV risk.
METHODS: In this secondary data analysis of the TARGET
trial, methotrexate (MTX) inadequate responders with RA were randomized to either add sulfasalazine and hydroxychloroquine (triple therapy), or TNFi for 24-weeks. The primary
trial outcome was the change in arterial inflammation measured in the carotid arteries or aorta by FDG-PET/CT at baseline and 24-weeks; this change was described as the target-to-background ratio (TBR) in the most diseased segment (MDS). Routine lipids and advanced lipoproteins were measured at baseline and 24-weeks; subjects on statin therapy at baseline were excluded. Comparisons between baseline and follow-up lipid measurements were performed within and across treatment arms, as well as change in lipids and change in MDS-TBR.
RESULTS: We studied 122 participants, 61 in each treatment arm, with median age 57 years, 76% female, and 1.5 year median RA disease duration. When comparing treatment arms, triple therapy had on average a larger reduction in triglycerides (15.9 mg/dL, p = 0.01), total cholesterol to HDL-C ratio (0.29, p-value = 0.01), and LDL particle number (111.2, p = 0.02) compared to TNFi. TNFi had on average a larger increase in HDL particle number (1.6umol/L, p = 0.006). We observed no correlation between change in lipid measurements and change in MDS-TBR within and across treatment arms.
CONCLUSIONS: Both treatment strategies were associated with improved lipid profiles via changes in different lipids and lipoproteins. These effects had no correlation with change in CV risk as measured by vascular inflammation by FDG-PET/CT.
BACKGROUND: ClinicalTrials.gov ID NCT02374021.