Baricitinib Induces LDL-C and HDL-C Increases in Rheumatoid Arthritis: A Meta-Analysis of Randomized Controlled Trials
This study confirmed that BARI induced a stable dose-dependent increase in LDL-C and HDL-C levels. There was no significant difference of CV risk between BARI and placebo groups.
High risk of CV events is strongly associated with RA. Mechanisms underlying the excess risk of CV events in RA remains unclear. This study aims to provide additional insight into the clinical safety of BARI, focusing on the effects of BARI on LDL-C and HDL-C levels and CV risk.
A Cochrane analysis was performed on studies reporting the effects of BARI on plasma lipids in RA patients. Net change scores (least square mean (LSM) and mean change) of LDL-C and HDL-C levels from baseline with the comparisons of BARI versus PBO were pooled respectively. The risk ratios (RR) of MACEs and differences of CV risk scores at the end of treatment across groups were compared.
BARI significantly increased the levels of LDL-C after treatment when compared to placebo. With the net LSM at 11.94 mg/dl and the net mean change at 13.15 mg/dl. HDL-C also increased after BARI treatment, with the net change at 7.19 mg/dl and net mean change at 5.40 mg/dl. Subgroup analysis and meta-regression demonstrated that, BARI-induced LDL-C and HDL-C increases in a dose-dependent manner, with no significant association found with treatment duration. Both the pooled RRs of MACEs and differences of CV risk scores were not statistically significant across groups.
This study confirms that BARI doses significantly induced LDL-C and HDL-C increases in RA patients when compared to placebo, while being strongly associated with treatment dose and not treatment duration. No significant difference of CV risk between BARI and placebo groups during the follow-up were found, although this issue cannot be completely dismissed.