Wu J, Wu JA, Xiang A, Rowan C, Poon K, Anthony M. Effect of tumor necrosis factor-alfa inhibitor and methotrexate therapy on total cholesterol, high-density lipoprotein, and low-density lipoprotein in psoriasis/psoriatic arthritis and rheumatoid arthritis patients. Poster presented at the American Academy of Dermatology 71st Annual Meeting; March 2013. [abstract] J Am Acad Dermatol. 2013 Apr; 68(4 Suppl 1):AB199. doi: 10.1016/j.jaad.2012.12.821

Objective: To understand the impact of treatment with a TNF inhibitor (TNFi) or methotrexate (MTX) on total cholesterol (TC), HDL, and LDL in psoriasis (PsO), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) patients.

Methods: The study population consists of adult patients diagnosed with prevalent or incident PsO/PsA/RA between January 1, 2002 and July 31, 2011 from a large HMO. Patients exposed to a TNFi (etanercept, adalimumab, infliximab, golimumab, and certolizumab pegol) ± MTX exposure comprised the TNFi group. Patients in the TNFi group were matched to patients exposed to MTX but not a TNFi (MTX group). Drug exposure status was determined based on exposure status within 15-45 days before the laboratory measurements. The groups were matched on inflammatory condition (PsO/PsA/RA), diabetes status, and the date of TNFi initiation/prevalent MTX exposure (index date). All patients had metabolic factor measurements within 1-year before and after the index date. Unadjusted median percent change from baseline and interquartile ranges (IQR) in TC, HDL, and LDL was determined in both exposure groups.

Results: There were 1249 PsO patients, 725 PsA patients, and 4962 RA patients. The TC median percent change was +0.4% in TNFi (IQR: -10.5, 10.8, n = 1122) and -0.9% in MTX (IQR: -9.8, 9.2, n = 4575) (P = .24). The HDL median percent change was 0% in TNFi (IQR: -10.2, 11.8, n = 1115) and 0% in MTX (IQR: -9.5, 12.3, n = 4577) (P = .26). The LDL median percent change was -2.2% in TNFi (IQR: 13.3-15.7, n = 937) and -1.2% in MTX (IQR: -14.7, 13.4, n = 4103) (P = .53).

Conclusion: Although TC was numerically higher in the TNFi group and lower in the MTX group, these changes were not statistically significant. HDL was unchanged in both groups. LDL was numerically lower in both groups, but these changes were not statistically significant. Analysis of other metabolic factors and comparisons between treatment groups and amongst the separate diseases while accounting for differences in medications and demographic and clinical factors are in process.