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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: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2017
- Publisher :
- John Wiley and Sons Inc., 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. 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. Conclusions Endothelial function is improved by tocilizumab in a high‐risk population, even as it increases total cholesterol and low‐density lipoprotein levels.
- Subjects :
- 0301 basic medicine
Male
Time Factors
Pilot Projects
Coronary Artery Disease
030204 cardiovascular system & hematology
Gastroenterology
Vascular Medicine
Severity of Illness Index
Coronary artery disease
Arthritis, Rheumatoid
chemistry.chemical_compound
0302 clinical medicine
endothelial function
Risk Factors
Prospective Studies
Prospective cohort study
Original Research
education.field_of_study
biology
Incidence
Middle Aged
Prognosis
Treatment Outcome
Rheumatoid arthritis
Antirheumatic Agents
Population Surveillance
Endothelium/Vascular Type/Nitric Oxide
Drug Therapy, Combination
Female
Cardiology and Cardiovascular Medicine
Brazil
Adult
medicine.medical_specialty
Population
Antibodies, Monoclonal, Humanized
03 medical and health sciences
tocilizumab
Tocilizumab
Internal medicine
medicine
Humans
Interleukin 6
education
Dose-Response Relationship, Drug
business.industry
Interleukin-6
dyslipidemia
medicine.disease
Atherosclerosis
Surgery
030104 developmental biology
chemistry
inflammation
biology.protein
Endothelium, Vascular
business
Dyslipidemia
Biomarkers
Lipoprotein
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 20479980
- Volume :
- 6
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Accession number :
- edsair.doi.dedup.....831a2321aad062b7621a0d3610e66db1