NEW YORK (Reuters Health)—Statin treatment is associated with an attenuation of the increases in serum lipids experienced by rheumatoid arthritis patients on tocilizumab, according to a post-hoc analysis of clinical trials.
Treatment with the interleukin-6 receptor-alpha inhibitor tocilizumab is known to raise total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride levels.
To explore the possible effect of statin treatment, Dr. Martin Soubrier from Universitaire de Clermont-Ferrand in France and colleagues analyzed data from seven international trials on 4,655 patients with rheumatoid arthritis who were treated with tocilizumab.
Most patients (84.8%) did not start statins during the study period, 9.5% were on concomitant statins at baseline, and 5.9% began to take the drugs during the study, the researchers report in Rheumatology and Therapy, online November 29.
Statin use at baseline was associated with the smallest increase in LDL-cholesterol over the first three to four months of tocilizumab treatment, whereas the initiation of treatment with statins was associated with the greatest increase in LDL-cholesterol over this time.
Between 24.8% and 31.8% (depending on tocilizumab dosing and combinations) of patients who were on statins at baseline experienced an increase in LDL-cholesterol from <130 mg/dL at baseline to >= 130 mg/dL at three to four months. This compared with 53.3% to 73.3% of those who initiated statins post-baseline and 36.7% to 42.4% of those who never initiated statins.
After the first three to four months, LDL-cholesterol varied little among patients on statins at baseline and among patients untreated with statins at any point, whereas LDL-cholesterol levels decreased gradually among patients who initiated statin therapy post-baseline.
Similar trends were observed for total cholesterol, HDL-cholesterol, and triglycerides.
At two years, about 78% of patients on intravenous tocilizumab had LDL-cholesterol >=100 mg/dL, but only 11.0% of those receiving tocilizumab monotherapy and 13.3% of those receiving tocilizumab combination therapy were taking statins.
“Tocilizumab is known to reduce chronic inflammation, and these results suggest that concomitant treatment with statins may attenuate lipid increases with tocilizumab treatment,” the researchers conclude.
“Taken together, these findings highlight the need for better understanding of potential risk associated with tocilizumab-mediated lipid elevations as well as development and implementation of rheumatoid arthritis-specific guidelines on the recognition and management of elevated risk of cardiovascular events in patients with rheumatoid arthritis,” they add.
Hoffman-La Roche, Ltd. funded this study, employed two of the four authors (at Genentech, Inc.), and provided honoraria for one of the other authors.
Dr. Soubrier did not respond to a request for comments.
Reference
Soubrier M, Pei J, Durand F, et al. Concomitant Use of Statins in Tocilizumab-Treated Patients with Rheumatoid Arthritis: A Post HocAnalysis. Rheumatol Ther. 2016 Nov 29. [Epub ahead of print].
