From the Guidelines
Management of hypertriglyceridemia in patients taking risankizumab should follow standard lipid management approaches, prioritizing lifestyle modifications and pharmacological interventions as needed, with a focus on reducing the risk of pancreatitis and cardiovascular disease. The most recent and highest quality study, 1, published in 2021, emphasizes the importance of limiting intake of added sugars, sugar-sweetened beverages, and desserts, and advises patients to consume whole fruit and avoid fruit juices when possible.
Lifestyle Modifications
Key lifestyle modifications include:
- Adopting a low-fat diet (less than 30% of calories from fat)
- Reducing alcohol consumption
- Increasing physical activity
- Achieving weight loss if overweight These modifications are crucial in managing hypertriglyceridemia, as they address the underlying causes of elevated triglyceride levels, such as weight gain, lack of exercise, and a diet rich in simple carbohydrates, as noted in 1 and 1.
Pharmacological Interventions
If triglyceride levels remain elevated (>500 mg/dL) despite lifestyle changes, pharmacological intervention is recommended.
- Fibrates (such as fenofibrate 145 mg daily or gemfibrozil 600 mg twice daily) are typically first-line medications for severe hypertriglyceridemia, as they are effective in reducing triglyceride levels and the risk of pancreatitis, as stated in 1 and 1.
- Omega-3 fatty acids (2-4 g daily) can be added or used as an alternative, offering an additional option for managing hypertriglyceridemia.
- For patients with moderate elevations (200-499 mg/dL), statins may be considered, especially if LDL cholesterol is also elevated, as they have a modest triglyceride-lowering effect and can help modify cardiovascular risk, as mentioned in 1 and 1.
Monitoring and Management
Regular monitoring of lipid levels every 3-6 months is important to assess treatment efficacy. Risankizumab itself does not significantly affect lipid metabolism, so the hypertriglyceridemia is likely due to other factors and can be managed without discontinuing the medication unless clinically indicated for other reasons. By following these guidelines and prioritizing the management of hypertriglyceridemia, patients taking risankizumab can effectively reduce their risk of pancreatitis and cardiovascular disease, ultimately improving their quality of life and outcomes.
From the Research
Management of Hypertriglyceridemia
- Hypertriglyceridemia is a common condition that affects approximately 33% of the US population, and is independently associated with cardiovascular disease (CVD) risk 2.
- The management of hypertriglyceridemia typically involves lifestyle modifications and pharmacologic therapies, such as statins, fibrates, niacin, and omega-3 fatty acids 2, 3, 4.
- For patients with severe hypertriglyceridemia (≥500 mg/dL), immediate use of triglyceride-lowering agents is recommended, while statins remain the first line of therapy for mild to moderate hypertriglyceridemia (150-499 mg/dL) 2.
- Omega-3 fatty acids have been shown to be effective in reducing triglyceride levels, and are a well-tolerated alternative to fibrates and niacin 2, 5.
- The use of omega-3 fatty acids (4 g/d) for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in the REDUCE-IT trial 5.
Treatment Options
- Fibrates are the first-line treatment in patients with severe hypertriglyceridemia 3.
- Statins in high doses exhibit a significant hypotriglyceridemic activity, and can be used in combination with other lipid-lowering agents 3, 4.
- Niacin is also a useful drug for patients with hypertriglyceridemia, but its use is limited by its side effects 2, 3.
- Gene therapy is under development for patients with known genetic abnormalities of triglyceride metabolism 3.
Considerations for Patients Taking Risankizumab
- There is limited information available on the management of hypertriglyceridemia in patients taking risankizumab.
- However, the general principles of managing hypertriglyceridemia, including lifestyle modifications and pharmacologic therapies, can be applied to patients taking risankizumab.
- It is essential to monitor triglyceride levels and adjust treatment as needed to minimize the risk of cardiovascular disease and other complications associated with hypertriglyceridemia 2, 3, 4, 5.