D3.433 - An effect on lipid profile of biologic therapy independent from weight variation

Eosinophilic asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and chronic spontaneous urticaria are conditions characterized by immune system dysregulation with type 2 inflammation. The aim of this study is to investigate the effects of currently approved biologic therapies in Italy (Dupilumab, Mepolizumab, Benralizumab, Tezepelumab, and Omalizumab) on lipid profile parameters in patients with T2 inflammatory diseases.

This retrospective study included 67 patients (49% male) affected by T2 diseases who started treatment with their first biologic and had adequate follow-up. Body mass index (BMI), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TG) were assessed at baseline (T0) and after 12 months of  biological (T12). None of the patients started statin during the 12-month follow-up and 17,2% of patients were already on statins at T0.

BMI was unchanged after 12 months of biologic (median BMI: 25 at T0 vs 24 at T12) while, a significant reduction in TC levels was observed (227 mg/dL at T0 vs 195 mg/dL at T12; p=0.041), mainly driven by a significant decrease in LDL (159.9 mg/dL vs 119.9 mg/dL; p=0.018). HDL cholesterol and TG levels also showed a reduction (median Δ  HDL=1 mg/dl; Δ TG=18mg/dl), although these changes did not reach significance (p>0.05). Analyzing the data according to the specific biologic, no significant differences were observed.

The lipid-lowering effect observed in our cohort seems to be independent of the specific biologic used. This effect may be partially explained by the reduction or discontinuation of systemic corticosteroid use. Another possible mechanism is the decrease in systemic inflammation, which may indirectly modulate lipid metabolism. Additional factors potentially contributing to the reduction in total and LDL cholesterol may include improved patient well-being and increased physical activity. Notably, the reduction in cholesterol levels occurred independently of weight loss, as BMI remained stable between T0 and T12. 

This study suggests that the benefits of biologic therapy in patients with T2 inflammatory diseases may extend beyond disease control, contributing to a reduction in systemic inflammation, decreased oral corticosteroid use, and a favorable impact on lipid metabolism independently by BMI. This may potentially imply an effect on cardiovascular risk.

Given the limitations related to the sample size and the monocentric design, future studies involving larger, multicenter cohorts are warranted