2026 Southeastern Residency Conference

Background:
Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal conditions characterized by symptoms of diarrhea, abdominal pain, and fatigue. Tumor necrosis factor (TNF)-alpha inhibitors are commonly used to treat these conditions by blocking activation of the pro-inflammatory cytokine TNF-alpha, which mediates inflammation in the gastrointestinal system. TNF-alpha inhibitors have a potential class-wide effect of causing hyperlipidemia; however, there is a paucity of data to show the extent to which hyperlipidemia can occur. To evaluate the prevalence and severity of changes in lipid profiles for patients prescribed TNF-α inhibitors for IBD.
Methods:
This single-center retrospective cohort study examined lipid panels of patients with IBD before and after initiation of TNF-alpha inhibitors. Included patients were age 18 or older, had a documented diagnosis of IBD, were taking a maintenance dose of a TNF-alpha inhibitor, and had lipid panels available within the 2 years before the TNF-alpha inhibitor was started and 2 to 5 years after the TNF-alpha inhibitor was started. Patients were excluded if they were taking TNF-alpha inhibitors for a condition other than IBD. The study period was individualized per patient, spanning from 2 years prior to up to 5 years after the TNF-alpha inhibitor start date. The primary objective of this study was to determine the volume of patients with an increase in either total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), or triglycerides after starting TNF-alpha inhibitor treatment. The secondary objective was to measure the change in lipid panel values after initiation of TNF-alpha inhibitor treatment. Data was collected by both electronic medical record reporting software and manual chart review by the investigator. Descriptive statistics were used for the primary objective, and the Wald Test was used for the secondary objective, controlling for variation within individuals and adjusting for lipid medications, cardiovascular diagnosis, and high or low dose medication status. 
Results:
Overall, 195 patients were included in this analysis. The most used TNF-alpha inhibitors were infliximab and biosimilar (56.4%), and adalimumab and biosimilar (40.6%). Among patients included, 29.2% were taking high-dose maintenance therapy, and 59.5% of patients had a concomitant cardiovascular disease state diagnosis (including hypertension, atherosclerotic vascular disease, hyperlipidemia, history of stroke/cerebrovascular accident or venous thromboembolism). During the study period, 30.7% of patients were taking anti-hyperlipidemic medications. After TNF-alpha inhibitor initiation, 52.3% of patients had an increase in total cholesterol, 20% had an increase in triglycerides, 49.2% had an increase in LDL, and 64.6% had an increase in HDL.  The mean increase in total cholesterol was 5.25 mg/dL (95% CI [0.53, 9.97]; p=0.029). The mean increase in HDL from baseline to follow-up was 4.3 mg/dL (95% CI [2.69, 5.91]; p<0.001). The mean changes in LDL and triglycerides from baseline to follow-up were not statistically significant.
Conclusions:
In this study, a statistically significant increase in total cholesterol and HDL was observed in patients taking maintenance doses of TNF-alpha inhibitors for inflammatory bowel disease. No statistically significant difference in triglyceride or LDL levels was observed. It is possible that the change in total cholesterol was driven by the increase in HDL levels, however, increases in HDL levels are typically advantageous from a cardiovascular disease prevention standpoint. More research is needed to determine if the change in cholesterol levels is clinically significant to cardiovascular risk in patients with inflammatory bowel disease. Limitations of the study include variations in lipid panel lab ordering by providers and an assumption that patients who received maintenance dosing of TNF-alpha inhibitors continued treatment throughout the study period. Additionally, while it was recorded if patients were taking antihyperlipidemic medications, we did not stratify these medications based on degree of lipid-lowering ability.