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Interleukin 6 Inhibition and Coronary Artery Disease in a High-Risk Population: A Prospective Community-Based Clinical Study.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2017 Mar 13; Vol. 6 (3). Date of Electronic Publication: 2017 Mar 13. - Publication Year :
- 2017
-
Abstract
- Background: Atherosclerosis is a chronic inflammatory disease, with interleukin 6 (IL-6) as a major player in inflammation cascade. IL-6 blockade may reduce cardiovascular risk, but current treatments to block IL-6 also induce dyslipidemia, a finding with an uncertain prognosis.<br />Methods and Results: We aimed to determine the endothelial function responses to the IL-6-blocking agent tocilizumab, anti-tumor necrosis factor α, and synthetic disease-modifying antirheumatic drug therapies in patients with rheumatoid arthritis in a 16-week prospective study. Sixty consecutive patients with rheumatoid arthritis were enrolled. Tocilizumab and anti-tumor necrosis factor α therapy were started in 18 patients each while 24 patients were treated with synthetic disease-modifying antirheumatic drugs. Forty patients completed the 16-week follow-up period. The main outcome was flow-mediated dilation percentage variation before and after therapy. In the tocilizumab group, flow-mediated dilation percentage variation increased statistically significantly from a pre-treatment mean of (3.43% [95% CI, 1.28-5.58] to 5.96% [95% CI, 3.95-7.97]; P =0.03). Corresponding changes were 4.78% (95% CI, 2.13-7.42) to 6.75% (95% CI, 4.10-9.39) ( P =0.09) and 2.87% (95% CI, -2.17 to 7.91) to 4.84% (95% CI, 2.61-7.07) ( P =0.21) in the anti-tumor necrosis factor α and the synthetic disease-modifying antirheumatic drug groups, respectively (both not statistically significant). Total cholesterol increased significantly in the tocilizumab group from 197.5 (95% CI, 177.59-217.36) to 232.3 (201.62-263.09) ( P =0.003) and in the synthetic disease-modifying antirheumatic drug group from 185.8 (95% CI, 169.76-201.81) to 202.8 (95% CI, 176.81-228.76) ( P =0.04), but not in the anti-tumor necrosis factor α group. High-density lipoprotein did not change significantly in any group.<br />Conclusions: Endothelial function is improved by tocilizumab in a high-risk population, even as it increases total cholesterol and low-density lipoprotein levels.<br /> (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Subjects :
- Adult
Arthritis, Rheumatoid complications
Arthritis, Rheumatoid metabolism
Biomarkers metabolism
Brazil epidemiology
Coronary Artery Disease epidemiology
Coronary Artery Disease etiology
Dose-Response Relationship, Drug
Drug Therapy, Combination
Endothelium, Vascular drug effects
Endothelium, Vascular metabolism
Endothelium, Vascular physiopathology
Female
Follow-Up Studies
Humans
Incidence
Interleukin-6 metabolism
Male
Middle Aged
Pilot Projects
Prognosis
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Antibodies, Monoclonal, Humanized administration & dosage
Antirheumatic Agents therapeutic use
Arthritis, Rheumatoid drug therapy
Coronary Artery Disease drug therapy
Interleukin-6 antagonists & inhibitors
Population Surveillance
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 6
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 28288972
- Full Text :
- https://doi.org/10.1161/JAHA.116.005038