Drug therapy drives lipid changes in inflammatory bowel disease

During inflammatory bowel disease (IBD) treatment, there appears to be a substantial elevation in total cholesterol levels that occurs with exposure to corticosteroids and tofacitinib but not with antitumour necrosis factor alpha (anti-TNFα) agents, according to the results of a meta-analysis.

Researchers accessed multiple online databases for randomized controlled trials and observational cohort studies that measured lipid levels before and after induction (≤10 weeks) and maintenance (>10 weeks) of IBD treatment.

Eleven studies, which comprised a total of 1,663 patients, were included in the meta-analysis. Of these, three studies examined the lipid effects of corticosteroids (n=73), four of anti-TNFα agents (n=207), five of tofacitinib (n=1257), one of filgotinib (n=128), and one of cyclosporine (n=72). In the tofacitinib cohorts, concomitant steroid use at baseline varied from 36.3 percent to 50 percent.

Pooled data, obtained using random effects models, showed a substantial elevation in total cholesterol following induction treatment with corticosteroids (1.19 mmol/L, 95 percent confidence interval [CI], 0.52–2.59) and tofacitinib (0.66 mmol/L, 95 percent CI, 0.42–0.79), but not after anti−TNFα treatment (−0.11 mmol/L, 95 percent CI, −0.26 to 0.36).

Similar differences were seen following maintenance treatment.

Treatment effects were strongly linked to age, but not with other factors. Changes in lipid levels were inversely correlated with but not modified by changes in C-reactive protein levels.

The present data support routine evaluation of lipid profiles in active IBD patients scheduled to initiate corticosteroids and JAK-STAT inhibitors in daily practice. Whether or not the change in total cholesterol associated with IBD treatment exerts an effect on cardiovascular risk warrants further study.