Background The increase of insulin resistance (IR) is observed in rheumatoid arthritis (RA). TNF-α and IL-6 appear to play a crucial role in the development of IR, type 2 Diabetes Mellitus (DM) as well as RA and ankylosing spondylitis (AS). Several recent studies have shown the beneficial effect of anti-TNF therapy on IR in RA.
Objectives The evaluation of biologic treatment effect (TNF-alpha inhibitors, tocilizumab and rituximab) on indicators of carbohydrate disorders and insulin resistance in patients (pts) with RA and AS.
Methods The first group included 60 patients with RA and average age - 52 [35; 65] years, mean DAS28 - 4,19 [1,41; 7,07]. In this group 20 patients were treated with biologic drugs: etanercept - 6, tocilizumab - 7, rituximab -7. The second group consisted of 42 patient with AS, average age of 38,8 [20; 61], mean BASDAI - 4,01 [0,6; 10], of whom 14 were treated with biologic drugs (etanercept-8, adalimumab-3, infliximab-3). The treatment duration time was at least 3 months in both groups. Fasting HbA1c levels and oral glucose tolerance test with glucose and insulin measurements at a time of 0,30,60,120 min. were performed. We analyzed the comparative incidence of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in both groups. Homeostasis Model Assessment (HOMA) and Insulin/Glucose index (I/G) were calculated to measure IR and the Quantitative Insulin Sensitivity Check index (QUICKI) and Matsuda index to measure insulin sensitivity.
Results In all pts (RA and AS) treated with etanercept (20), compared to non-treated, a statistically significant lower incidence of IGT - 0/14 vs.10/88, (p<0,05) was found, with no effect on IFG, and a statistically significant improvement of mean value of all indices of IR HOMA-IR (1,09 vs.1,72), I/G (0,05 vs. 0,09), and QUICKI (0,38 vs.0,36), Matsuda (10,86 vs.7,74) (p<0.05) were found. In the group of AS pts treated with adalimumab there were no significant effects on the incidence of IGT and IGF as well as IR indices. In the group treated with infliximab a statistically significant increase in the mean value of I/G -0,09 vs. 0,05 (p<0.05) was observed. In contrast, the effects on IGT and IGF across all of TNF-alpha antagonists, a highly significant reduction in the prevalence of IGT - 0,0% vs. 12,2% (p<0,01), reduction of I/G- 0,05 vs. 0,09 (p=0,05), as well as increased mean value of Matsuda index - 9,53 vs. 7,87 (p=0,05) were found. In the group of RA patients treated with tocilizumab a significant reduction in incidence of IGT was found in comparison to the untreated group - 0,0% vs. 15,09%, (p<0,05), whereas in patients on rituximab therapy an increased incidence of IFG - 42,86% vs. 3,77% (p=0,01) was shown.
Conclusions TNF-alpha inhibitors, especially etanercept, seem to have a beneficial effect on impaired glucose tolerance occurrence and insulin resistance. Anti-IL-6 therapy with tocilizumab may have a favorable effect on the reduction of prevalence of IGT.
Disclosure of Interest None declared
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