33
Table 12. RA Treatments with Manufacturer Package Inserts
Recommending Frequency of Lipid Measurements
RA treatment
Rates of
dyslipidemia Recommendations Comments
Tofacitinib >10% 4-8 weeks aer
initiation
Increases in total-C,
LDL-C and HDL-C
• Maximum increases
within 6 weeks of
initiation
Tocilizumab >10% 4-8 weeks aer
initiation, then at
~24-week intervals
Increases in total-C,
LDL-C, HDL-C and
triglycerides
Residual Risk After Statins and
Lifestyle Modification
Î Progressively more intensive lowering of low-density lipoprotein
cholesterol (LDL-C) (and non-high-density lipoprotein cholesterol
[non-HDL-C]) is associated with progressively greater risk reduction.
Î Over a period of approximately 5 years, each 1% reduction in LDL-C or
non-HDL-C is associated with a reduction of approximately 1% in risk
for a CHD event.
Î Many patients receiving lipid-modifying treatment have residual risk,
even if the treatment produces a robust response and the patient is
fully adherent.
Î When the patient's cholesterol level is not at goal on maximal
tolerated statin therapy, it is reasonable to consider further
atherogenic cholesterol lowering by adding lipid-altering therapy to
ongoing statin therapy, as long as the patient has sufficient ASCVD
risk to warrant it, and the expected treatment benefit outweighs the
risk for adverse consequences.
