THU0197 Effects of tocilizumab, an anti-interleukin-6 receptor antibody, on serum lipid and adipokine levels in patients with rheumatoid arthritis
Authors: E. Hoffman, M.A. Rahat, J. Feld, M. Elias, I. Rosner, L. Kaly, I. Lavi, D. Zisman
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease.<sup>1</sup> Dyslipidemia is a known adverse reaction to tocilizumab (TCZ), the anti-interleukin-6 receptor antibody, used in RA treatment. <h3>Objectives</h3> To assess the effect of TCZ on lipid and adipokine levels in the serum of RA patients <h3>Methods</h3> Forty RA patients with active disease initiating TCZ treatment and 40 healthy matched controls were included. Height, weight, disease activity score (DAS28), lipid profile and atherogenic indices (AI) were measured before and four months after TCZ treatment initiation. Serum concentrations of leptin, adiponectin, resistin, interleukin-6 and high sensitivity CRP were measured by ELISA in both study groups. Statistical analysis: The differences in clinical and laboratory data of RA patients between baseline and follow up were assessed by paired t-test and by linear mixed models with repeated measures for adipokines levels after adjustment to BMI, statin treatment and disease duration. To compare the adipokines levels between RA and control groups adjusted to baseline BMI and statin treatment we used ANCOVA models. HsCRP and IL-6 were compared between the two groups by two-tailed Mann Whitney test. The results were considered statistically significant when p≤0.05. <h3>Results</h3> The average age of the study population was 57.5±11 years, 82.5% were women, with a disease duration of 8.7±5.6 years. The majority of the patients responded to TCZ and reduced their diseases activity from DAS28 score of 5.45±1.06 to 3.46±1.37 (p&lt;0.0001). Following treatment, a significant elevation of total cholesterol (199±52 to 221±53 mg/dl, p&lt;0.01), HDL (55±19 to 59±23 mg/dl, p&lt;0.01) and triglycerides (140±69 to 168±107, p=0.04), and no significant changes in weight, BMI, low density lipoprotein (LDL) and AI were found. Significantly higher adiponectin levels (5.59±2.39 vs. 3.75±1.63 ng/ml, p&lt;0.0001), lower resistin levels (16.25±7.17 vs. 21.53±8.19 pg/ml, p=0.007) and leptin/adiponectin ratio (6.44±6.44 vs.5.52±6.08, p=0.03) were measured in the RA group compared to controls after adjustment to BMI and statin treatment. Four months after TCZ treatment a statistically significant decrease in adiponectin (4.53±2.12 ng/ml p&lt;0/0001), resistin levels (20.42±8.06 pg/ml, p=0.01) and leptin/adiponectin ratio (7.99±7.84, p=0.002) were measured after adjustment to BMI, statin treatment and disease duration. The levels of hsCRP decreased significantly (3.37±2.0 vs 0.74±1.36 mg/dl, p&lt;0.001) and IL-6 increased significantly (13.15±25.43 vs 99.80±97.97 pg/ml, p&lt;0.001) following treatment. <h3>Conclusions</h3> The impact of TCZ treatment on lipid metabolism is complex. The elevation in HDL without change in AI, and the tendency toward normalisation of the adipokine profile observed, suggests a protective role of TCZ treatment against the cardiovascular burden in RA patients. <h3>Reference</h3> [1] Lago F, Gomez R, et al. Cardiometabolic comorbidities and rheumatic diseases: focus on the role of fat mass and adipokines. Arthritis Care Res2011; 63:1083–90. <h3>Disclosure of Interest</h3> None declared