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Meta-Analysis
. 2024 Mar 4:15:1354593.
doi: 10.3389/fimmu.2024.1354593. eCollection 2024.

Effects of tumor necrosis factor-alpha inhibitors on lipid profiles in patients with psoriasis: a systematic review and meta-analysis

Liang Su #  1   2 , Chunyan Xu #  3 , Hong Huang  1   2 , Peilian Zhang  1   2 , Jinrong Wang  1   2 , Xiaoyong Ouyang  1   2 , Xuesong Yang  1   2 , Jianzhou Ye  1   2
Affiliations
Meta-Analysis

Effects of tumor necrosis factor-alpha inhibitors on lipid profiles in patients with psoriasis: a systematic review and meta-analysis

Liang Su et al. Front Immunol. .

Abstract

Background: There is no consensus on the effect of tumor necrosis factor-alpha (TNF-alpha) inhibitors on lipid profiles in patients with psoriasis. This study aimed to investigate the effects of TNF-alpha inhibitors on lipid profiles (triglycerides, total cholesterol, low-density lipoprotein, or high-density lipoprotein) in patients with psoriasis.

Methods: We searched PubMed, Embase, and Cochrane Library databases for articles published before October 17, 2023. Four TNF-alpha inhibitors (infliximab, etanercept, adalimumab, and certolizumab) were included in our study. (PROSPERO ID: CRD42023469703).

Results: A total of twenty trials were included. Overall results revealed that TNF-alpha inhibitors elevated high-density lipoprotein levels in patients with psoriasis (WMD = 2.31; 95% CI: 0.96, 3.67; P = 0.001), which was supported by the results of sensitivity analyses excluding the effect of lipid-lowering drugs. Subgroup analyses indicated that high-density lipoprotein levels were significantly increased in the less than or equal to 3 months group (WMD = 2.88; 95% CI: 1.37, 4.4; P < 0.001), the etanercept group (WMD = 3.4; 95% CI = 1.71, 5.09, P < 0.001), and the psoriasis group (WMD = 2.52; 95% CI = 0.57, 4.48, P = 0.011). Triglyceride levels were significantly increased in the 3 to 6-month group (WMD = 4.98; 95% CI = 1.97, 7.99, P = 0.001) and significantly decreased in the 6-month and older group (WMD = -19.84; 95% CI = -23.97, -15.7, P < 0.001). Additionally, Triglyceride levels were significantly increased in the psoriasis group (WMD = 5.22; 95% CI = 2.23, 8.21, P = 0.001).

Conclusion: Our results revealed that TNF-alpha inhibitors might temporarily increase high-density lipoprotein levels in patients with psoriasis. However, changes in triglycerides were not consistent among the different durations of treatment, with significant increases after 3 to 6 months of treatment. Future prospective trials with long-term follow-up contribute to confirming and extending our findings.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023469703.

Keywords: lipid profiles; meta-analysis; psoriasis; systematic review; tumor necrosis factor alpha (TNF-alpha); tumor necrosis factor alpha inhibitors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram for the study selection process.
Figure 2
Figure 2
Forest plot for the effect of TNF-alpha inhibitors on triglycerides in patients with psoriasis (weighted mean difference).
Figure 3
Figure 3
Forest plot for the effect of TNF-alpha inhibitors on total cholesterol in patients with psoriasis (weighted mean difference).
Figure 4
Figure 4
Forest plot for the effect of TNF-alpha inhibitors on high-density lipoprotein in patients with psoriasis (weighted mean difference).
Figure 5
Figure 5
Forest plot for the effect of TNF-alpha inhibitors on low-density lipoprotein in patients with psoriasis (weighted mean difference).
See this image and copyright information in PMC

References

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