Background Prevalence of DM in patients with gout is high, but the influence of glucocorticoids (GC) and inhibitors IL-1β on their carbohydrate metabolism has not been investigated thoroughly. Anti-inflammatory effects connected with IL-1 inhibition are supposed to decrease the risk of DM .
Objectives To compare the effects of a single injection of canacinumab or betametazone on glucose metabolism and pro-inflammatory cytokine serum levels in patients with gout.
Methods Open-label prospective randomized study of 40 patients with gout (37 m, 3 f), mean age 51,3±11,3 years, was performed. Inclusion criteria: crystal-proven gout, acute arthritis. Exclusion criteria: infections, sub- or decompensation of DM and use of anti-diabetic drugs. 20 patients received one dose of canakinumab 150 mg subcutaneously, 20 patients received one dose of betametazone 7 mg intraarticular. Basal and postprandial glucose (PPG) level was performed 120 min before injection and 24, 48 h and 14, 90 days after injection. Cytokine level was detected using of “xMAP” technology (Human Grp I Cytokine 27-plex panel) and on the analyzer “BioPlex-200” (Bio-Rad, the USA) before injection and 14 and 90 days after injection. Glycosylated hemoglobin (HbA1c) was determined by borate affinity assay.
Results At baseline, glycemic levels (basal, PPG), HbA1c and cytokines in both groups were identical. Glycemic level ≥6,1 mmol/l and or PPG ≥11,1 mmol/l was detected in all patients injected betametazone in 24 hours, in 6 patients in 48 hours, in 4 patients in 14 days and in 3 patients in 90 days after the injection. There were no patients in study who were injected canacinumab with glycemic level ≥6,1 mmol/l and/or PPG ≥11,1 mmol/l. HbA1c level in a betametazone group in 90 days increased (from 5,83±0,49% to 6,01±0,60%), and on the contrary, in a canacinumab group decreased (from 5,75±0,55% to 5,61±0,50%), but the difference was not accurate. In a canacinumab group serum levels of IL-1β and IL-6 positively decreased on 14th and 90th days of study. Serum level of other cytokines in groups during the study did not change fundamentally.
Conclusions In patients with gout who take intraarticular injections of GC, the risk of DM progression can be underestimated. In contrast, canacinumab taking can be connected with decreasing the risk of DM through the influence on the levels of IL-1β and IL-6. To study the influence of the medicines on carbohydrate metabolism further research is needed.
Noe A., Howard C., Thuren T. and al. Pharmacokinetic and Pharmacodynamic Characteristics of Single-dose Canakinumab in Patients With Type 2 Diabetes Mellitus. Clin Ther. 2014;36(11):1625-37.
Disclosure of Interest None declared