Impact of TNF-α inhibitor on lipid profile and atherogenic index of plasma in axial spondyloarthritis: 2-year follow-up data from the Catholic Axial Spondyloarthritis COhort (CASCO)

  • Hong Ki Min
  • Jennifer Lee
  • Ji Hyeon Ju
  • Sung-Hwan Park
  • Seung-Ki KwokEmail author
Brief Report


To evaluate the influence of TNF-α inhibitor on lipid profile and atherogenic index of plasma (AIP) in axial spondyloarthritis (axSpA) patients with long-term use of stable dose TNF-α inhibitor. AxSpA patients were enrolled in the Catholic Axial Spondyloarthritis COhort (CASCO). We collected their data annually and analyzed their lipid profile and AIP. Comparison was conducted between TNF-α inhibitor user group and non-user group. Additionally, lipid profile and AIP of TNF-α inhibitor user group were compared over 2 years. A total of 238 axSpA patients were enrolled for the present study, including 132 TNF-α inhibitor users and 106 non-users. Changes of total cholesterol (TC), TG, low-density lipoprotein cholesterol (LDL-C), and HDL-C over 2 years did not show significant difference between TNF-α inhibitor user group and non-user group. When baseline data and 2-year follow-up data were compared within the TNF-α inhibitor user group, there was no significant increase in TG, LDL-C, HDL-C, or AIP. Only TC level was slightly increased in the 2-year follow-up data for the TNF-α inhibitor user group (177.86 ± 28.73 vs. 183.08 ± 29.82, P = 0.019). Long-term use of stable dose TNF-α inhibitor did not increase atherogenic lipid profile or AIP compared to the control group. Furthermore, atherogenic lipid profile or AIP was not increased significantly in the TNF-α inhibitor user group over the 2-year follow-up. Therefore, using TNF-α inhibitor for a long term might not affect atherosclerosis of axSpA.

Key Points

Managing risk factors of cardiovascular disease (CVD) such as dyslipidemia in axSpA is important because axSpA patients have increased risk of CVD.

Using TNF-α inhibitor for 2 years with stable dose did not deteriorate atherogenic lipid profile or AIP as predictor of atherosclerosis.

Maintaining stable dose of TNF-α inhibitor for long-term in axSpA may be relatively safe for managing atherogenic lipid.


Atherogenic index of plasma Atherosclerosis Axial spondyloarthritis Lipid profile TNF-α inhibitor 


Compliance with ethical standards

This study was conducted in accordance with the Declaration of Helsinki ((1964 Declaration of Helsinki and its later amendments). Written informed consent was obtained from each patient. This study was approved by the Institutional Review Board of Seoul St. Mary’s Hospital (approval number: KC15OISI0012).




  1. 1.
    Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Sodergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DP, Nurmohamed MT (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76:17–28. CrossRefGoogle Scholar
  2. 2.
    Bengtsson K, Forsblad-d'Elia H, Lie E, Klingberg E, Dehlin M, Exarchou S, Lindstrom U, Askling J, Jacobsson LTH (2017) Are ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events? A prospective nationwide population-based cohort study. Arthritis Res Ther 19:102. CrossRefGoogle Scholar
  3. 3.
    Di Minno MN, Ambrosino P, Peluso R, Di Minno A, Lupoli R, Dentali F (2014) Lipid profile changes in patients with rheumatic diseases receiving a treatment with TNF-alpha blockers: a meta-analysis of prospective studies. Ann Med 46:73–83. CrossRefGoogle Scholar
  4. 4.
    Dobiasova M, Frohlich J (2001) The plasma parameter log (TG/HDL-C) as an atherogenic index: correlation with lipoprotein particle size and esterification rate in apoB-lipoprotein-depleted plasma (FER(HDL)). Clin Biochem 34:583–588CrossRefGoogle Scholar
  5. 5.
    Cure E, Icli A, Uslu AU, Sakiz D, Cure MC, Baykara RA, Yavuz F, Arslan S, Kucuk A (2018) Atherogenic index of plasma: a useful marker for subclinical atherosclerosis in ankylosing spondylitis : AIP associate with cIMT in AS. Clin Rheumatol 37:1273–1280. CrossRefGoogle Scholar
  6. 6.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria Arthritis Rheum 27:361–368Google Scholar
  7. 7.
    Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, Dougados M, Hermann KG, Landewe R, Maksymowych W, van der Heijde D (2009) The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis 68(Suppl 2):ii1–i44. CrossRefGoogle Scholar
  8. 8.
    Dobiasova M (2006) AIP--atherogenic index of plasma as a significant predictor of cardiovascular risk: from research to practice. Vnitr Lek 52:64–71Google Scholar
  9. 9.
    Dougados M, Simon P, Braun J, Burgos-Vargas R, Maksymowych WP, Sieper J, van der Heijde D (2011) ASAS recommendations for collecting, analysing and reporting NSAID intake in clinical trials/epidemiological studies in axial spondyloarthritis. Ann Rheum Dis 70:249–251. CrossRefGoogle Scholar
  10. 10.
    van der Heijde D, Kivitz A, Schiff MH, Sieper J, Dijkmans BA, Braun J, Dougados M, Reveille JD, Wong RL, Kupper H, Davis JC Jr (2006) Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 54:2136–2146. CrossRefGoogle Scholar
  11. 11.
    Hassan S, Milman U, Feld J, Eder L, Lavi I, Cohen S, Zisman D (2016) Effects of anti-TNF-alpha treatment on lipid profile in rheumatic diseases: an analytical cohort study. Arthritis Res Ther 18:261. CrossRefGoogle Scholar
  12. 12.
    Ivanova EA, Myasoedova VA, Melnichenko AA, Grechko AV, Orekhov AN (2017) Small dense low-density lipoprotein as biomarker for atherosclerotic diseases. Oxidative Med Cell Longev 2017:1273042. CrossRefGoogle Scholar
  13. 13.
    Cure E, Icli A, Ugur Uslu A, Aydogan Baykara R, Sakiz D, Ozucan M, Yavuz F, Arslan S, Cumhur Cure M, Kucuk A (2017) Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behcet disease. Z Rheumatol 76:259–266. CrossRefGoogle Scholar
  14. 14.
    Uslu AU, Kucuk A, Icli A, Cure E, Sakiz D, Arslan S, Baykara RA (2017) Plasma Atherogenic Index is an independent indicator of subclinical atherosclerosis in systemic lupus erythematosus. Eurasian J Med 49:193–197. CrossRefGoogle Scholar
  15. 15.
    Mathieu S, Dubost JJ, Tournadre A, Malochet-Guinamand S, Ristori JM, Soubrier M (2010) Effects of 14 weeks of TNF alpha blockade treatment on lipid profile in ankylosing spondylitis. Joint Bone Spine 77:50–52. CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Hong Ki Min
    • 1
  • Jennifer Lee
    • 2
  • Ji Hyeon Ju
    • 2
  • Sung-Hwan Park
    • 2
  • Seung-Ki Kwok
    • 2
    Email author
  1. 1.Division of Rheumatology, Department of Internal MedicineKonkuk University Medical Center, Konkuk University School of MedicineSeoulRepublic of Korea
  2. 2.Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea

Personalised recommendations