The effect of adjunctive infliximab treatment on future cardiovascular disease risk in patients with bipolar disorder,Journal of Affective Disorders

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The effect of adjunctive infliximab treatment on future cardiovascular disease risk in patients with bipolar disorder
Journal of Affective Disorders ( IF 4.9 ) Pub Date : 2022-07-22 , DOI: 10.1016/j.jad.2022.07.020
Hartej Gill ₁ , Nelson B Rodrigues ₂ , Rodrigo B Mansur ₃ , CéAnn A Marks ₄ , Joshua D DiVincenzo ₂ , Felicia Ceban ₅ , Joshua D Rosenblat ₆ , Bing Cao ₇ , Jonathan M Lieberman ₄ , Roger Ho ₈ , Roger S McIntyre ₉

Affiliation

Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada.
Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China.
Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Health Innovation and Technology (IHealthtech), National University of Singapore, Singapore, Singapore.
Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.

Introduction

Bipolar disorder (BD) is characterized by a pro-inflammatory biotype, and is a major cause of cardiovascular disease (CVD), consequently causing elevated rates of morbidity and mortality among individuals with BD.

Methods

The present study is based on a 12-week clinical trial assessing the antidepressant effects of adjunctive infliximab treatment in BD. Generalized estimating equation (GEE) models were used to evaluate CVD risk in people with BD following adjunctive infliximab treatment at baseline and week 12. Participants (baseline: n = 40; endpoint: 33) were randomized for an infliximab-treatment or placebo group. CVD-risk was calculated using Framingham risk scores (FRS), mean arterial blood pressure (MAP) and total cholesterol (TC).

Results

There was no main effect of treatment on FRS in infliximab-treated participants compared to controls (p = 0.408). Similarly, there were no significant differences in MAP between the infliximab-treated and control group (p = 0.796). The effect of treatment on TC was not significant (p = 0.130), however, an evaluation across time suggested the main effect of the group was significant at week 0 (p = 0.01), but not week 12 (p = 0.219).

Limitations

Cardiovascular disease was not an outcome of the original clinical trial, and our participant group did not have a high CVD-risk at baseline.

Conclusion

There were no significant treatment effects of infliximab on FRS, MAP and TC. The current study highlights the complexity of immune-system targets that influence CVD in psychiatric populations. Future studies should include a large scale, combinatorial omnibus biomarker approach to evaluate the immune and vascular link in BD.

中文翻译：

英夫利昔单抗辅助治疗对双相情感障碍患者未来心血管疾病风险的影响

介绍

双相情感障碍 (BD) 以促炎生物型为特征，是心血管疾病 (CVD) 的主要原因，因此导致 BD 患者的发病率和死亡率升高。

方法

本研究基于一项为期 12 周的临床试验，评估英夫利昔单抗辅助治疗 BD 的抗抑郁作用。广义估计方程 (GEE) 模型用于评估 BD 患者在基线和第 12 周辅助英夫利昔单抗治疗后的 CVD 风险。参与者（基线：n  = 40；终点：33）被随机分配到英夫利昔单抗治疗组或安慰剂组。使用弗雷明汉风险评分 (FRS)、平均动脉血压 (MAP) 和总胆固醇 (TC) 计算 CVD 风险。

结果

与对照组相比，在英夫利昔单抗治疗的参与者中，治疗对 FRS 没有主要影响（p  = 0.408）。同样，英夫利昔单抗治疗组和对照组之间的 MAP 没有显着差异（p  = 0.796）。治疗对 TC 的影响不显着（p  = 0.130），然而，跨时间评估表明该组的主要影响在第 0 周（p  = 0.01）显着，但在第 12 周不显着（p  = 0.219）。