AB0903 TREATMENT OF AXIAL SPONDYLOARTHRITIS AND ITS IMPACT ON BLOOD LIPID LEVELS - A RETROSPECTIVE COHORT STUDY
Authors: C. Dürrschmid, H. Lechner-Radner, D. Aletaha, D. Sieghart
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Patients with chronic inflammatory rheumatic diseases have a higher risk for cardiovascular (CV) diseases [1]. Hyperlipidemia as a well-known CV-risk factor, therefore recommended to be regularly monitored by blood lipid levels (total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL]) [2]. Inflammatory processes as well as DMARD therapy [2] can alter those blood lipid levels and therefore potentially mask cardiovascular risk. Studies focusing on patient with axial spondyloarthritis (axSpA) are still sparse. <h3>Objectives:</h3> The study aimed to investigate the impact of disease activity as well as DMARD therapy with tumor necrosis factor alpha inhibitors (TNFi) or interleukin-17 inhibitors (IL17i) on blood lipid levels and in patients with axSpA, and to analyze if the impact differs between mode of action. <h3>Methods:</h3> Blood lipid levels and disease activity (as assessed by C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], BASDAI and BASFI) at baseline and 3 months after starting DMARD therapy were compared via Wilcoxon Test; changes were calculated and compared between TNFi and IL-17i using Mann-Whitney-U Test. Correlation of disease activity and blood lipid levels and its changes over 3 months were performed. To predict if cholesterol levels increase after 3 months after DMARD start a multivariate binary regression analysis was performed, adjusting for age, sex, change of CRP and mode of action (TNFi vs. IL17i). <h3>Results:</h3> In total 173 treatment courses of 130 patients were included of which 90 were used for further analyses (70 TNFi [78%] and 20 IL17i [22%]). All disease activity markers were significantly lower 3 months after DMARD start in the TNFi group, the IL17i group showed a significant decrease in BASFI. Concerning lipid levels, only patients receiving TNFi showed a significant increase in HDL (<i>p</i> &lt; 0.01). In IL-17 numerical decrease in HDL, LDL, and TC was observed. When comparing both groups, differences in HDL and TC changes (<i>p</i> &lt; 0.02) were found. Correlations of changes in blood lipid levels and markers of disease activity were modest and of an inverse nature (ρ from -0.52 to -0.22) in the TNFi group. When attempting to predict if TC increases or decreases only change in CRP was a significant indicator (B = -0.612, <i>p</i> &lt; 0.05). <h3>Conclusion:</h3> Differences between the modes of action were detected after 3 months of DMARD therapy. In the TNFi group it led to an increase in HDL after 3 months. In patients receiving IL17i lipid levels decrease over this period, though these outcomes may be caused by the small sample size. Change in disease activity markers inversely correlate with change in lipid levels. For the future, research on a larger IL17i group by including data from different centers would be beneficial. <h3>REFERENCES:</h3> [1] Behl, T., Kaur, I., Sehgal, A., Zengin, G., Brisc, C., Brisc, M. C., Munteanu, M. A., Nistor-Cseppento, D. C., &amp; Bungau, S. (2020). The Lipid Paradox as a Metabolic Checkpoint and Its Therapeutic Significance in Ameliorating the Associated Cardiovascular Risks in Rheumatoid Arthritis Patients. Int J Mol Sci, 21(24). https://doi.org/10.3390/ijms21249505 [2] Mach, F., Baigent, C., Catapano, A. L., Koskinas, K. C., Casula, M., Badimon, L., Chapman, M. J., De Backer, G. G., Delgado, V., Ference, B. A., Graham, I. M., Halliday, A., Landmesser, U., Mihaylova, B., Pedersen, T. R., Riccardi, G., Richter, D. J., Sabatine, M. S., Taskinen, M. R.,... Wiklund, O. (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 41(1), 111 - 188. https://doi.org/10.1093/eurheartj/ehz455 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>