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P225. Effects of TNF-α antagonists on lipid profile in patients with IBD

M. Cappello, L. Amato, I. Bravatà, C. Randazzo, P.L. Almasio, A. Craxì

University of Palermo, Palermo, Italy

Introduction: Studies in patients with rheumatoid arthritis or ankylosing spondilytis show that anti-tumor necrosis factor (TNF) agents may alter lipid profile and reduce the atherogenic risk. Data on patients with IBD are scanty, with one study of a small case series reporting an increase of total cholesterol, HDL cholesterol and Apo A-1 levels. The aim of our study was to investigate the effects of anti-TNF alpha agents on lipid levels in a cohort of Italian patients with IBD.

Methods: 54 patients with IBD (21 males, median age 45 yrs, range 20–69) undergoing anti-TNFα therapy were assessed. Forty three had Crohn's disease (CD), 11 had ulcerative colitis (UC); 23 patients received infliximab at weeks 0, 2 and 6 and subsequently every 8 weeks. 14 patients received adalimumab at weeks 0, 2 and 4 and subsequently every other week and 17 patients received infliximab and then switched to adalimumab for loss of response or intolerance to infliximab. Clinical and demographic characteristics and results of blood tests (including lipid profile: total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides) and Body Mass Index (BMI) were assessed at baseline and at the last follow up visit. Statistical analysis was carried out in order to compare all variables at baseline and at the end of follow-up. Differences were tested by the Student's t test for paired data.

Results: Mean duration of anti-TNF therapy was 22.4 months (range 1–95). Remission was achieved in 38 (70.4%) patients. A significant difference of blood levels at baseline and at the end of follow-up was observed for total cholesterol (179.1±43.9 mg/dl vs. 191.7±46.9 mg/dl, p = 0.034) but not for HDL, LDL cholesterol and triglycerides levels. The increase of total cholesterol was significant in the subgroup of patients who received adalimumab (either naïve or previously treated with infliximab). BMI increased from 23.97±3.96 to 24.47±4.19 (p = 0.016) and it was mainly related to treatment response.

Conclusion: Our data show that the effects of TNF-alpha antagostists on lipid profile are mostly limited to a modest raise of total cholesterol, thus not confirming the trend observed in rheumatological settings. Close monitoring of lipid levels in patients with IBD under anti-TNF therapy is hence not recommended.