Psoriatic arthritis: tofacitinib linked to increased LDL, HDL cholesterol

  • Gladman DD & al.
  • Arthritis Care Res (Hoboken)
  • 21/05/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Tofacitinib (Xeljanz) is associated with increases in low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) among patients with psoriatic arthritis (PsA), but lipid ratios remained unchanged.
  • Hypertension adverse events and major cardiovascular events (MACE) were slightly elevated, consistent with other PsA treatments.

Why this matters

  • Findings suggest that tofacitinib is not associated with increased cardiovascular risk.

Study design

  • Pooled analysis of 2 phase 3 placebo-controlled trials (OPAL Broaden and OPAL Beyond) and 1 long-term extension trial (OPAL Balance).
  • Tofacitinib was given at doses of 5 or 10 mg twice daily plus conventional synthetic disease-modifying antirheumatic drugs.
  • Funding: Pfizer Inc.

Key results

  • Increases from baseline (range, 9%-14%) in mean percentage of both LDL-C and HDL-C:
    • LDL-C increased 9.2% and 14.0% at 5- and 10-mg doses at 3 months, respectively.
    • HDL-C increased 10.0% and 14.0%, respectively.
    • LDL-C and HDL-C increases stabilized by month 6.
  • No meaningful changes were observed in 2 key lipid ratios: LDL-C/HDL-C and total cholesterol/HDL-C.
  • 7.4% of patients had hypertension-related adverse events (incidence rate [IR] per 100 patient-years, 4.81; 95% CI, 3.65-6.22) vs 2.1% of placebo-treated.
  • 0.6% had MACE (IR, 0.24; 95% CI, 0.05-0.70), 2 fatal, vs 0% of placebo-treated.

Limitations

  • Overall extent of exposure to placebo was less than tofacitinib.