Effects of infliximab treatment on insulin resistance in patients with rheumatoid arthritis and ankylosing spondylitis

Dimitrios N Kiortsis ¹, Anastasios K Mavridis ², Spyros Vasakos ², Spyros N Nikas ³ and Alexandros A Drosos ^3*

¹ Laboratory of Physiology, Medical School, University of Ioannina, Ioannina, Greece
² Laboratory of Microbiology, Medical School, University of Ioannina, Ioannina, Greece
³ Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Greece

^* To whom correspondence should be addressed. E-mail: adrosos{at}cc.uoi.gr.

Accepted 1 September 2004

Abstract

Objective: Tumor necrosis factor alpha (TNF- alpha) might be an important mediator of insulin resistance. Infliximab is a chimeric monoclonal, high- affinity antibody against the soluble and trans-membrane TNF-alpha. It can reduce significantly the biological activity of circulating and tissue TNF-alpha and is used in the treatment of various autoimmune disorders. The purpose of the study was to assess the effects of infliximab infusions on insulin sensitivity in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).

Methods: Forty-five patients (28 with RA and 17 with AS) aged 19 to 74 years were studied. All patients were treated with intravenous infliximab. A complete biochemical profile was performed before and after 6 months of treatment with infliximab. As a measure of insulin resistance the Homeostasis Model Assessment (HOMA) index was used and as a measure of insulin sensitivity the Quantitative Insulin Sensitivity Check Index (QUICKI) index was used.

Results: In the whole study population group, no significant changes of HOMA index or of QUICKI index were observed. However, in the tertile of patients with the highest insulin resistance, a significant decrease of HOMA index and increase of QUICKI index was found (p<0.01 for both parameters).

Conclusions: The results of the present study may indicate that infliximab treatment might have beneficial effects on insulin sensitivity in the most insulin resistant patients with RA and AS.

Keywords: Ankylosing spondylitis, Infliximab, Insulin resistance, Rheumatoid arthritis, Tumor necrosis factor alpha

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