Trajectory of lipid profiles in rheumatoid arthritis patients receiving tofacitinib: Evidence from the prospective CENTRA cohort

AIMS: The cardiovascular risk of tofacitinib has been highly concerned. In this study, we investigated the trajectory of lipid profiles in patients with rheumatoid arthritis (RA) after receiving tofacitinib. METHODS: Patients were recruited from the prospective CENTRA cohort of RA patients. The data of RA disease activity, triglyceride (TG), total cholesterol (TCHO), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL) and ratios of TCHO/HDL and LDL/HDL were collected at baseline, week 4, 12, 24 and 52. Lipid and lipoprotein concentrations were compared between the tofacitinib exposure group and the non-exposure group by propensity score matching (PSM). RESULTS: Totally 374 patients were enrolled, with 137 received tofacitinib and 237 not. After 4 weeks of tofacitinib treatment, the levels of TG, TCHO, HDL and LDL were increased. TCHO and LDL concentrations returned to baseline levels by weeks 24 and 52, respectively, while TG and HDL levels remained elevated throughout 52 weeks. After 1:1 PSM, 133 patients in tofacitinib exposure group and 133 in non-exposure group were identified. Compared to the non-exposure group, the tofacitinib-exposure group showed significantly increased TCHO levels at week 4 and continuously higher TCHO levels till week 24; HDL and LDL levels were also elevated from week 12 to week 24. CONCLUSIONS: Four-week exposure to tofacitinib induced elevation of TG, TCHO, HDL and LDL in serum. LDL and TCHO returned to baseline levels at week 24 and week 52, respectively; nevertheless, TG and HDL displayed continued elevated levels. Tofacitinib exposure was generally associated with a more remarkable elevation of lipid profiles.