Treatments for rheumatoid arthritis (RA) are associated with complex changes in lipids and lipoproteins that may impact cardiovascular (CV) risk. The objective of this study was to examine lipid and lipoprotein changes associated with two common RA treatment strategies, triple therapy or tumor necrosis factor inhibitor (TNFi), and association with CV risk. In this secondary data analysis of the TARGET trial, methotrexate (MTX) inadequate responders with RA were randomized to either add sulfasalazine and hydroxychloroquine (triple therapy), or TNFi for 24-weeks. The primary trial outcome was the change in arterial inflammation measured in the carotid arteries or aorta by FDG-PET/CT at baseline and 24-weeks; this change was described as the target-to-background ratio (TBR) in the most diseased segment (MDS). Routine lipids and advanced lipoproteins were measured at baseline and 24-weeks; subjects on statin therapy at baseline were excluded. Comparisons between baseline and follow-up lipid measurements were performed within and across treatment arms, as well as change in lipids and change in MDS-TBR. We studied 122 participants, 61 in each treatment arm, with median age 57 years, 76% female, and 1.5 year median RA disease duration. When comparing treatment arms, triple therapy had on average a larger reduction in triglycerides (15.9 mg/dL, p = 0.01), total cholesterol to HDL-C ratio (0.29, p-value = 0.01), and LDL particle number (111.2, p = 0.02) compared to TNFi. TNFi had on average a larger increase in HDL particle number (1.6umol/L, p = 0.006). We observed no correlation between change in lipid measurements and change in MDS-TBR within and across treatment arms. Both treatment strategies were associated with improved lipid profiles via changes in different lipids and lipoproteins. These effects had no correlation with change in CV risk as measured by vascular inflammation by FDG-PET/CT. ClinicalTrials.gov ID NCT02374021.

中文翻译：

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RA 治疗策略对类风湿关节炎血脂和血管炎症的影响：TARGET 随机主动比较试验的二次分析


类风湿性关节炎 (RA) 的治疗与脂质和脂蛋白的复杂变化有关，可能会影响心血管 (CV) 风险。本研究的目的是检查与两种常见 RA 治疗策略（三联疗法或肿瘤坏死因子抑制剂 (TNFi)）相关的脂质和脂蛋白变化，以及与 CV 风险的关系。在 TARGET 试验的二次数据分析中，甲氨蝶呤 (MTX) 反应不充分的 RA 患者被随机分为添加柳氮磺吡啶和羟氯喹（三联疗法）或 TNFi，为期 24 周。主要试验结果是在基线和 24 周时通过 FDG-PET/CT 测量颈动脉或主动脉的动脉炎症变化；这种变化被描述为患病最严重部分（MDS）中的目标与背景比（TBR）。在基线和 24 周时测量常规血脂和高级脂蛋白；基线时接受他汀类药物治疗的受试者被排除在外。在治疗组内和治疗组之间进行基线和后续血脂测量之间的比较，以及血脂的变化和 MDS-TBR 的变化。我们研究了 122 名参与者，每个治疗组 61 名，中位年龄 57 岁，76% 为女性，中位 RA 病程为 1.5 年。比较治疗组时，三联疗法平均甘油三酯（15.9 mg/dL，p = 0.01）、总胆固醇与 HDL-C 比率（0.29，p 值 = 0.01）和 LDL 颗粒数（111.2， p = 0.02) 与 TNFi 相比。 TNFi 平均显着增加 HDL 颗粒数 (1.6umol/L, p = 0.006)。我们观察到治疗组内和治疗组间血脂测量值的变化与 MDS-TBR 的变化之间没有相关性。 两种治疗策略均通过改变不同脂质和脂蛋白来改善血脂状况。这些影响与 FDG-PET/CT 血管炎症测量的 CV 风险变化没有相关性。 ClinicalTrials.gov ID NCT02374021。