Psoriatic Arthritis, Cardiovascular Health Improved With Etanercept Therapy

Etanercept (ETN) therapy reduces clinical markers of disease activity in patients with psoriatic arthritis (PsA) while also stabilizing cardiovascular disease risk factors over a period of 5 years, according to results recently published in the Journal of Rheumatology.

Rabia Agca, MD, from the Amsterdam Rheumatology and Immunology Center and VU University Medical Center in Amsterdam, The Netherlands, and colleagues evaluated 118 consecutive patients with PsA who received weekly (50 mg) or twice-weekly (25 mg) ETN therapy alone or with methotrexate or prednisone for 5 years. Patients were a median of 47±13 years old with a baseline median diagnosis of PsA of 13 years and a median diagnosis of arthritis for a minimum of 6 years. Nearly 40% and 74.6% of patients had hypertension and dyslipidemia at baseline, respectively, and 56.8% of the cohort was overweight.

Follow-up visits occurred at 1, 3, 6, and 12 months and every 12 months after up to 5 years. The researchers used the Psoriasis Area and Severity Index, C-reactive protein (CRP), Disease Activity Score in 28 joints (DAS28), and erythrocyte sedimentation rate (ESR) outcome scores to determine disease activity at follow-up visits.

Dr Agca and colleagues found a significant decrease in DAS28, CRP, and ESR scores, with the greatest decrease occurring within the first month of initiating ETN therapy. Patients who discontinued treatment at 28 weeks had high scores for DAS28 (3.13±1.65 vs 1.98±1.08; P =.003), CRP (2 [median], 1-2 [interquartile range] vs 2, 1-3; P =.049), and ESR (9, 3-30 vs 4, 2-8, P =.028). For patients who discontinued treatment at 52 weeks, scores remained high for DAS28 (2.86±1.45 vs 1.62±0.94; P =.001), CRP (5, 2-10 vs 1, 1-2; P =.003), and ESR (19, 5-39 vs 4, 2-7, P =.009) outcomes. Patients also had significant increases in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol over the course of 5 years, but the total cholesterol:high-density lipoprotein cholesterol ratio remained the same.

In a subset of 81 patients, the apolipoprotein B:apolipoprotein A-I ratio significantly decreased over the course of 5 years, with increased CRP associated with the decreased apolipoprotein B:apolipoprotein A-I ratio (β, 0.03; 95% CI, 0.004-0.05; P =.02).

The researchers said a decrease in total cholesterol, triglycerides, and low-density lipoprotein cholesterol is often seen in patients with PsA taking anti-inflammatory drugs as cardiovascular disease (CVD) risk increases. “During treatment with antiinflammatory agents, lipid levels increase in these patients, leading to a normalization of lipid levels. In our study, we demonstrated that this phenomenon also holds true for PsA, ie, treatment with ETN increases lipid levels,” Dr Agca and colleagues wrote. “This increase in lipids should probably be considered as a normalization of serum lipid levels and a reflection of effective antiinflammatory therapy rather than an adverse effect of ETN.”

The researchers noted that the small changes in lipid profile do not account for the CV benefits seen in patients taking ETN.

“Modulation of lipids and other known CVD risk factors probably only partially explains the favorable effects of anti-TNF therapy on CVD risk,” Dr Agca and colleagues wrote. “Hence, the presumed beneficial effects of [tumor necrosis factor inhibitor] on CVD risk in PsA appear to be mediated by other mechanisms, likely related to inflammation.”

Limitations of the study included small lipid level changes and apolipoprotein values in a small subset of patients.

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Reference

Agca R, Heslinga M, Kneepkens EL, et al. The effects of 5-year etanercept therapy on cardiovascular risk factors in patients with psoriatic arthritis [published online June 1, 2017]. J Rheumatol. doi:10.3899/jrheum.161418