Treatment of IBD with steroids and tofacitinib increases cholesterol levels: Study

Inflammatory bowel disease (IBD) is associated with an increased risk of cardiovascular disease however prevalence of obesity, hypertension and dyslipidaemia are similar or even lower in IBD patients compared to the general population. Dr Jasmijn A. M. Sleutje and team have found in a new study that a combination of corticosteroids and tofacitinib increased total cholesterol levels but was inverse for TNF-α treatment in IBD patients. The study has been published in Alimentary Pharmacology and Therapeutics.

The objective of the study was to evaluate the effect of different IBD drug classes on lipid profile, as Sleutjes and team stated that "Patients with an active chronic inflammatory disease have lower levels of total cholesterol, HDL-cholesterol (HDL-c) and LDL-cholesterol (LDL-c) compared with patients who are in disease remission and the general population. This so-called "lipid paradox" has been mirrored in other inflammatory states" and It is unknown if lipid levels are affected similarly by all classes of IBD therapy.

The researchers conducted a systematic literature search of randomised controlled trials and observational cohort studies that assessed lipid levels before and after induction (≤10 weeks) and maintenance (>10 weeks) of IBD treatment. Data of 11 studies (1663 patients) were pooled using random effects models. The influence of patient and disease characteristics on treatment effects on total cholesterol levels was analysed in 6 studies (1211 patients) for which individual data were available, using linear mixed models.

They found that there was a statistically significant increase in total cholesterol levels after induction treatment with corticosteroids (+1.19 mmol/L, 95% confidence interval [CI95] +0.52 to +2.59), and tofacitinib (+0.66 mmol/L, CI95 +0.42 to +0.79), but not after anti-TNF α treatment (−0.11 mmol/L, CI95 −0.26 to +0.36 mmol/L). Similar differences were observed after maintenance treatment. Treatment effects were significantly related to age, but not with other factors. Lipid changes were inversely correlated with but not modified by CRP changes.

They concluded that "Increase in total cholesterol levels was strongest for corticosteroids followed by tofacitinib but was not observed for anti-TNFα agents. Whether total cholesterol change associated with IBD treatment has an effect on cardiovascular risk requires further study"

For further information: https://doi.org/10.1111/apt.16580