Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study
Toka Alsulaim, Noor Alhassan, Hala Khalil, Abdullah Almutlaq
Abstract
Objective. To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events. Methods. A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6–12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded. Results. Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>high</a:mtext> <a:mtext> </a:mtext> <a:mtext>cholesterol</a:mtext> <a:mtext> </a:mtext> <a:mtext>levels</a:mtext> <a:mo>≥</a:mo> <a:mn>5.2</a:mn> <a:mtext> </a:mtext> <a:mtext>mmol</a:mtext> <a:mo>/</a:mo> <a:mtext>L</a:mtext> </a:math> and <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>LDL</c:mtext> <c:mo>≥</c:mo> <c:mn>3.37</c:mn> <c:mtext> </c:mtext> <c:mtext>mmol</c:mtext> <c:mo>/</c:mo> <c:mtext>L</c:mtext> </c:math> in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> </e:math> 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> </g:math> 0.03). Conclusion. There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.