Document Detail

Changes in lipoproteins associated with methotrexate or combination therapy in early rheumatoid arthritis: results from the treatment of early rheumatoid arthritis trial.
MedLine Citation:
PMID:  23460074     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To study changes in lipid profiles at 24 weeks among patients with early rheumatoid arthritis (RA) participating in the Treatment of Early RA (TEAR) trial and randomized to receive methotrexate (MTX) plus etanercept, triple therapy (MTX plus sulfasalazine plus hydroxychloroquine), or aggressively titrated MTX monotherapy.
METHODS: This TEAR substudy included 459 participants with biologic specimens. Serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol were measured at 0 and 24 weeks.
RESULTS: At 24 weeks, there were statistically significant increases in mean cholesterol levels in the MTX plus etanercept, triple therapy, and MTX monotherapy arms. The observed increases were 31.4 mg/dl, 28.7 mg/dl, and 30 mg/dl in LDL cholesterol, 19.3 mg/dl, 22.3 mg/dl, and 20.6 mg/dl in HDL cholesterol, and 56.8 mg/dl, 53 mg/dl, and 57.3 mg/dl in total cholesterol (P < 0.0001 versus baseline for each comparison). There was a statistically significant decrease in the ratio of total cholesterol to HDL cholesterol at 24 weeks in all 3 treatment groups versus baseline. There was no difference in any lipid changes between the 3 treatment arms. After multivariable adjustment, change in C-reactive protein, but not the Disease Activity Score in 28 joints, was associated with change in LDL cholesterol (P = 0.03) and total cholesterol (P = 0.01). Baseline glucocorticoid use was associated with changes in HDL cholesterol (P = 0.03) and total cholesterol (P = 0.02).
CONCLUSION: Levels of total cholesterol, LDL cholesterol, and HDL cholesterol increased comparably shortly after initiation of MTX plus etanercept, triple therapy, and MTX monotherapy among patients with early RA with active disease participating in a clinical trial. The clinical relevance of short-term changes in traditional lipids on cardiovascular outcomes remains to be determined.
Iris Navarro-Millán; Christina Charles-Schoeman; Shuo Yang; Joan M Bathon; S Louis Bridges; Lang Chen; Stacey S Cofield; Louis J Dell'Italia; Larry W Moreland; James R O'Dell; Harold E Paulus; Jeffrey R Curtis
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  65     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-06-03     Completed Date:  2013-08-13     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1430-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
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MeSH Terms
Antirheumatic Agents / administration & dosage,  therapeutic use*
Arthritis, Rheumatoid / drug therapy*
Cholesterol, HDL / blood*
Cholesterol, LDL / blood*
Drug Therapy, Combination
Hydroxychloroquine / administration & dosage,  therapeutic use
Immunoglobulin G / administration & dosage*,  therapeutic use*
Methotrexate / administration & dosage,  therapeutic use*
Middle Aged
Receptors, Tumor Necrosis Factor / administration & dosage*,  therapeutic use*
Sulfasalazine / administration & dosage,  therapeutic use
Treatment Outcome
Grant Support
5K23-HL-094834/HL/NHLBI NIH HHS; AR-053351/AR/NIAMS NIH HHS; K23 AR053351/AR/NIAMS NIH HHS; K23 HL094834/HL/NHLBI NIH HHS; R01-AR-052658/AR/NIAMS NIH HHS; R01-HS-018517/HS/AHRQ HHS; R21-AR-057913-01A1/AR/NIAMS NIH HHS
Reg. No./Substance:
0/Antirheumatic Agents; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Immunoglobulin G; 0/Receptors, Tumor Necrosis Factor; 185243-69-0/TNFR-Fc fusion protein; 3XC8GUZ6CB/Sulfasalazine; 4QWG6N8QKH/Hydroxychloroquine; YL5FZ2Y5U1/Methotrexate

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