Four-year Follow up of Atherogenicity in Rheumatoid Arthritis Patients: From Nationwide Korean College of Rheumatology Biologics Registry

Abstract Background: To evaluate the impact of biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) on lipid profile and atherogenic index of plasma (AIP) in rheumatoid arthritis (RA) patients, and to compare the occurrence of dyslipidaemia between patients using bDMARDs, tsDMARDs, or conventional DMARDs (cDMARDs).Methods: Data for lipid profile, AIP, and occurrence of dyslipidaemia were collected from the Korean College of Rheumatology BIOlogics registry. A comparison was conducted between patients using bDMARDs (tumour necrosis factor (TNF)-α inhibitor, tocilizumab, abatacept), janus kinase inhibitors (JAKis), and cDMARDs. The Kaplan-Meier method was used to compare the occurrence of dyslipidaemia between groups, and hazard ratios (HR) were calculated using the cox proportional hazard method.Results: Data of a total of 917, 826, 789, 691, and 520 RA patients were eligible for analysis at the baseline, 1-year, 2-year, 3-year, and 4-year follow ups, respectively. Baseline total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were higher in the cDMARDs group, whereas AIP was comparable. During the 4-year follow up, AIP was comparable between the groups. Occurrence of dyslipidaemia did not show a significant difference when comparing the bDMARDs/tsDMARDs and cDMARDs groups (P=0.06), or the TNF-α inhibitor, tocilizumab, abatacept, JAKi, and cDMARD user groups (P=0.3). In the multivariate cox proportional hazard model, older age (HR=1.03, P=0.005) and concomitant hypertension (HR=2.21, P=0.013) were significantly associated with dyslipidaemia occurrence.Conclusion: Long term use of bDMARDs and tsDMARDs is relatively safe with regards to lipid profile, AIP, and the occurrence of dyslipidaemia in RA patients.