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Abstract
In this study, the effects of etanercept, anakinra, and their combination on streptozotocin-induced type 2 diabetes in rats were pathologically evaluated. A total of 30 rats were separated into 5 groups as control (C), diabetes (D), diabetes + anakinra (DA), diabetes + etanercept (DE), and diabetes + anakinra + etanercept (DAE). Anakinra (10 mg/kg/day, s.c.) and etanercept (10 mg/kg, twice weekly, s.c.) were administered to the DA and DE groups, respectively, and the DAE group received both anakinra and etanercept for 21 days. Histopathologically, pathological changes related to diabetes in internal organs occurred in the diabetes group, and there was a significant decrease (improvement) in these changes in the treatment groups (P < 0.05). There was no significant difference (P > 0.05) between the treatment groups, but some changes in the liver and kidneys were higher in the combined group which should be taken into account for longer use. Although there was no significant difference, etanercept was more effective on pancreatic lesion scores and anakinra was more effective on testicular changes. As a result, the single or combined use of IL-1 and TNF-α antagonists anakinra and etanercept were effective in the treatment of type 2 diabetes in rats without any toxic-pathological effect.
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Pannu S, Rosmarin D. Psoriasis in Patients with Metabolic Syndrome or Type 2 Diabetes Mellitus: Treatment Challenges. Am J Clin Dermatol 2021; 22:293-300. [PMID: 33586126 DOI: 10.1007/s40257-021-00590-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 12/14/2022]
Abstract
Psoriasis is a chronic inflammatory disease that affects 2-3% of the population worldwide. It is associated with plaques, psoriatic arthritis, and metabolic syndrome and its components, including obesity, diabetes, dyslipidemia, nonalcoholic fatty liver disease, and cardiovascular disease. In this review, we highlight the shared pathogenic pathways leading to the comorbid existence of both diseases and the impact of drugs used for psoriasis on metabolic syndrome and vice versa. Persistent inflammation is common to both diseases. They share increased inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin-6. Biologics have revolutionized the treatment of plaque psoriasis and also have a positive impact on metabolic syndrome. There is some evidence that TNFα inhibitors decrease insulin resistance and improve glycemic indices. Some psoriasis treatments may result in decreased body weight. Lifestyle measures used in the management of metabolic syndrome, such as weight loss, exercise, and healthy diet, are beneficial in patients with psoriasis. Considering the association between metabolic syndrome and psoriasis, we recommend screening patients with psoriasis for metabolic syndrome with clinical examinations and laboratory tests. Patients with a co-diagnosis of these diseases deserve special attention for optimal treatment.
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Affiliation(s)
- Sukhmani Pannu
- The Department of Dermatology, Tufts Medical Center, Boston, MA, USA
| | - David Rosmarin
- The Department of Dermatology, Tufts Medical Center, Boston, MA, USA.
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3
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Genovese MC, Burmester GR, Hagino O, Thangavelu K, Iglesias-Rodriguez M, John GS, González-Gay MA, Mandrup-Poulsen T, Fleischmann R. Interleukin-6 receptor blockade or TNFα inhibition for reducing glycaemia in patients with RA and diabetes: post hoc analyses of three randomised, controlled trials. Arthritis Res Ther 2020; 22:206. [PMID: 32907617 PMCID: PMC7488252 DOI: 10.1186/s13075-020-02229-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes is common in patients with rheumatoid arthritis (RA). Interleukin (IL)-6 is implicated in both the pathogenesis of RA and in glucose homeostasis; this post hoc analysis investigated the effects of IL-6 receptor vs. tumour necrosis factor inhibition on glycosylated haemoglobin (HbA1c) in patients with RA with or without diabetes. Methods Data were from two placebo-controlled phase III studies of subcutaneous sarilumab 150/200 mg q2w + methotrexate or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and a phase III monotherapy study of sarilumab 200 mg q2w vs. adalimumab 40 mg q2w. Patients with diabetes were identified by medical history or use of antidiabetic medication (patients with HbA1c ≥ 9% were excluded from all three studies). HbA1c was measured at baseline and weeks 12/24. Safety and efficacy were assessed in RA patients with or without diabetes. Results Patients with diabetes (n = 184) were older, weighed more and exhibited higher RA disease activity than patients without diabetes (n = 1928). Regardless of diabetes status, in patients on background csDMARDs, least squares (LS) mean difference (95% CI) in change from baseline in HbA1c for sarilumab 150 mg/200 mg vs. placebo at week 24 was − 0.28 (− 0.40, − 0.16; nominal p < 0.0001) and − 0.42 (− 0.54, − 0.31; nominal p < 0.0001), respectively. Without csDMARDs, LS mean difference for sarilumab 200 mg vs. adalimumab 40 mg at week 24 was − 0.13 (− 0.22, − 0.04; nominal p = 0.0043). Greater reduction in HbA1c than placebo or adalimumab was observed at week 24 with sarilumab in patients with diabetes and/or baseline HbA1c ≥ 7%. There was no correlation between baseline/change from baseline in HbA1c and baseline/change from baseline in C-reactive protein, 28-joint Disease Activity Score, or haemoglobin, nor between HbA1c change from baseline and baseline glucocorticoid use. Medical history of diabetes or use of diabetes treatments had limited impact on safety and efficacy of sarilumab and was consistent with overall phase III findings in patients with RA. Conclusions In post hoc analyses, sarilumab was associated with a greater reduction in HbA1c than csDMARDs or adalimumab, independent of sarilumab anti-inflammatory effects. Prospective studies are required to further assess these preliminary findings. Trial registration ClinTrials.gov NCT01061736: date of registration February 03, 2010; ClinTrials.gov NCT01709578: date of registration October 18, 2012; ClinTrials.gov NCT02332590: date of registration January 07, 2015.
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Affiliation(s)
- Mark C Genovese
- Division of Immunology and Rheumatology, Stanford University Medical Center, 1000 Welch Road, Suite 203, Palo Alto, CA, 94304, USA.
| | - Gerd R Burmester
- Charité University Medicine, Free University and Humboldt University of Berlin, Berlin, Germany
| | | | | | | | - Gregory St John
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.,Present address: Intercept Pharmaceuticals, Inc., New York, NY, USA
| | - Miguel A González-Gay
- University of Cantabria Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | - Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, TX, USA
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Dal Bello G, Gisondi P, Idolazzi L, Girolomoni G. Psoriatic Arthritis and Diabetes Mellitus: A Narrative Review. Rheumatol Ther 2020; 7:271-285. [PMID: 32306243 PMCID: PMC7211212 DOI: 10.1007/s40744-020-00206-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory spondyloarthropathy associated with psoriasis. PsA is frequently associated with metabolic disorders including, obesity, metabolic syndrome, and diabetes mellitus (DM). Type 2 DM is among the most common metabolic disorders, with a prevalence ranging from 2.4 to 14.8% in the general population. METHODS We conducted a narrative review of the English-language studies from January 1989 to September 2019 investigating the risk of type 2 DM in patients with PsA, the pathogenic mechanism linking DM to PsA, and the effects on insulin sensitivity exerted by systemic therapies for PsA. RESULTS The prevalence of type 2 DM in patients with PsA ranges from 6.1 to 20.2%, generally higher when compared to the general population. The higher risk of DM is reported in women with more severe forms of PsA. Elevated serum levels of adipokines, including TNF-α, which inhibits the autophosphorylation of the insulin receptor and suppresses the expression of glucose transporter 4, favor insulin resistance and could partially explain the association between PsA and DM. Moreover, adiponectin and omentin, with insulin-sensitizing and anti-atherogenic properties, are decreased in patients with PsA. Some of the treatments for PsA could affect the glucose homeostasis. Systemic corticosteroids are known to impair insulin resistance, whereas apremilast (phosphodiesterase type 4 inhibitor) and TNF-α inhibitors could exert neutral effect or reduce the insulin-resistance. The role of IL-17 or IL-23 inhibitors has been marginally investigated. CONCLUSIONS Patients affected by PsA have a higher prevalence of type 2 DM compared with the general population. The mechanism linking PsA with DM has not been completely clarified, but some of the principal mediators could be TNF-α and adipokine, especially adiponectin and omentin. Apremilast and TNF-α inhibitor may have a favorable effect and could be safely used in patients with DM.
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Affiliation(s)
- Giacomo Dal Bello
- Section of Dermatology, Department of Medicine, University of Verona, 37126, Verona, Italy.
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine, University of Verona, 37126, Verona, Italy
| | - Luca Idolazzi
- Section of Rheumatology, Department of Medicine, University of Verona, 37126, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, 37126, Verona, Italy
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5
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Shuwa HA, Dallatu MK, Yeldu MH, Ahmed HM, Nasir IA. Effects of Adalimumab, an Anti-tumour Necrosis Factor-Alpha (TNF-α) Antibody, on Obese Diabetic Rats. Malays J Med Sci 2018; 25:51-62. [PMID: 30914847 PMCID: PMC6422540 DOI: 10.21315/mjms2018.25.4.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 05/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background Diabetes mellitus (DM) represents a major health problem worldwide. Recent studies have confirmed that obesity is a state of chronic inflammation that is characterised by increased concentrations of tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and other inflammatory markers. It has been reported that increased TNF-α and IL-6 cause an immunological disturbance in DM. In the present study, the levels of fasting glucose, TNF-α and IL-6 were estimated in order to determine whether adalimumab can improve the glucose levels in obese diabetic rats. Materials and methods Twenty-eight Wistar rats were divided into four groups: obese + diabetes + adalimumab (group 1), obese + diabetes (group 2), obese (group 3) and normal control (group 4), respectively (n = seven per group). Obesity was induced by feeding the rats in groups 1, 2 and 3 with a high-fat diet for four weeks. Some 30 mg/kg of streptozotocin (STZ) was administered to groups 1 and 2 so as to induce diabetes. Adalimumab was administered at a rate of 50 mg/kg to group 1 following the induction of diabetes. The fasting glucose, TNF-α and IL-6 concentrations were determined. Results A significant decrease was observed in the glucose levels of the treated rats (6.91 [0.11] mmol/L) when compared to those of the untreated rats (15.43 [0.44] mmol/L) (P < 0.001). The TNF-α levels were lower in group 1 (20.71 [0.35] ng/L) than in groups 2 (37.90 [0.27] ng/L) and 3 (25.89 [0.12] ng/L) (P < 0.001), although they were higher when compared to the levels seen in group 4 (12.44 [0.38] ng/L) (P < 0.001). The IL-6 concentrations were found to be elevated in groups 1 (22.89 [0.45] ng/L), 2 (21.00 [0.40] ng/L) and 3 (31.80 [1.32] ng/L) when compared to the levels seen in group 4 (18.70 [0.37] ng/L) (P < 0.001), although they were lower in group 1 (22.89 [0.45] ng/L) than in group 3 (31.80 [1.32] ng/L) (P < 0.001). Conclusion Adalimumab reduced the glucose and TNF-α levels of diabetic rats, which indicates that it has a therapeutic effect in terms of controlling the blood glucose.
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Affiliation(s)
- Halima Ali Shuwa
- Department of Immunology, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Muhammad Kabiru Dallatu
- Department of Chemical Pathology, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Muhammed Haruna Yeldu
- Department of Immunology, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Hamidu Marafa Ahmed
- Department of Immunology, Faculty of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Idris Abdullahi Nasir
- Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, FCT Abuja, Nigeria
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6
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DiK B, Bahcivan E, Eser Faki H, Uney K. Combined treatment with interleukin-1 and tumor necrosis factor-alpha antagonists improve type 2 diabetes in rats. Can J Physiol Pharmacol 2018; 96:751-756. [PMID: 29558631 DOI: 10.1139/cjpp-2017-0769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the present study, combined treatment with etanercept and anakinra were tested in the streptozotocin-induced diabetic rats. Forty male Wistar albino rats were divided into 5 groups: healthy control (HC), diabetic control (DC), diabetic + anakinra (DAT), diabetic + etanercept (DET), and diabetic + etanercept + anakinra (DEAT). HC and DC groups received subcutaneous (s.c.) injection with a saline solution, while DAT and DET groups received anakinra (10 mg/kg per day, s.c.) or etanercept (10 mg/kg, twice a week, s.c.), and DEAT rats received both anakinra and etanercept treatments for 21 days after diabetes has developed. Anakinra and etanercept treatments significantly increased insulin and homeostatic model assessment β-cell function levels and decreased glucose levels compared to the DC group as single (DAT and DET) and combined treatments (DEAT). The thiobarbituric acid reactive substances level was significantly decreased in DAT group. The combine use of etanercept and anakinra can improve insulin and blood glucose in type 2 diabetic rats. The combined treatment of anakinra and etanercept together was more effective than single treatment and might have a potential new treatment strategy and to reduce the mortality and morbidity resulting from diabetes.
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Affiliation(s)
- Burak DiK
- Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130.,Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130
| | - Emre Bahcivan
- Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130.,Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130
| | - Hatice Eser Faki
- Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130.,Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130
| | - Kamil Uney
- Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130.,Department of Pharmacology and Toxicology, Veterinary Faculty, University of Selcuk, Konya, Turkey, 42130
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7
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Pfeifer EC, Saxon DR, Janson RW. Etanercept-Induced Hypoglycemia in a Patient With Psoriatic Arthritis and Diabetes. J Investig Med High Impact Case Rep 2017; 5:2324709617727760. [PMID: 29721512 PMCID: PMC5917447 DOI: 10.1177/2324709617727760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/20/2017] [Accepted: 07/29/2017] [Indexed: 12/12/2022] Open
Abstract
Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis and inflammation involving the axial skeleton and/or peripheral joints. It is more likely to be associated with metabolic syndrome and diabetes when compared with other inflammatory arthritides. Tumor necrosis factor-α (TNF-α) is one of several cytokines often elevated in rheumatologic disorders including PsA and has also been found to be elevated in patients with obesity, metabolic syndrome, diabetes, and/or atherosclerotic disease. We describe the case of a patient with PsA as well as poorly controlled type 2 diabetes mellitus who experienced not only improvement in his psoriasis and arthritis with the anti-TNF-α agent etanercept but also recurrent hypoglycemia and significant improvement in hemoglobin A1c despite discontinuation of all conventional therapy for diabetes.
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Affiliation(s)
- Emily C Pfeifer
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - David R Saxon
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Robert W Janson
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.,Denver Veterans Affairs Medical Center, Denver, CO, USA
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8
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Carvalho AVED, Romiti R, Souza CDS, Paschoal RS, Milman LDM, Meneghello LP. Psoriasis comorbidities: complications and benefits of immunobiological treatment. An Bras Dermatol 2017; 91:781-789. [PMID: 28099601 PMCID: PMC5193190 DOI: 10.1590/abd1806-4841.20165080] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/02/2015] [Indexed: 01/04/2023] Open
Abstract
During the last decade, different studies have converged to evidence the high
prevalence of comorbidities in subjects with psoriasis. Although a causal
relation has not been fully elucidated, genetic relation, inflammatory pathways
and/or common environmental factors appear to be underlying the development of
psoriasis and the metabolic comorbidities. The concept of psoriasis as a
systemic disease directed the attention of the scientific community in order to
investigate the extent to which therapeutic interventions influence the onset
and evolution of the most prevalent comorbidities in patients with psoriasis.
This study presents scientific evidence of the influence of immunobiological
treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept
and ustekinumab) on the main comorbidities related to psoriasis. It highlights
the importance of the inflammatory burden on the clinical outcome of patients,
not only on disease activity, but also on the comorbidities. In this sense,
systemic treatments, whether immunobiologicals or classic, can play a critical
role to effectively control the inflammatory burden in psoriatic patients.
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Affiliation(s)
| | - Ricardo Romiti
- Universidade de São Paulo (USP) - São Paulo (SP), Brazil
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9
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Pilla SJ, Quan AQ, Germain-Lee EL, Hellmann DB, Mathioudakis NN. Immune-Modulating Therapy for Rheumatologic Disease: Implications for Patients with Diabetes. Curr Diab Rep 2016; 16:91. [PMID: 27525682 PMCID: PMC6031126 DOI: 10.1007/s11892-016-0792-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Immune modulators used to treat rheumatologic disease have diverse endocrine effects in patients with diabetes. Providers should be aware of these effects given that diabetes and rheumatologic disease overlap in prevalence and cardiovascular morbidity. In patients with type 1 diabetes, clinical trials have demonstrated that immune modulators used early in the disease can improve pancreatic function, though their efficacy in adults with longstanding autoimmune diabetes is unknown. In patients with type 2 diabetes, hydroxychloroquine is an effective antihyperglycemic and may be preferred for rheumatologic use in patients with difficult glycemic control. In patients without diabetes, hydroxychloroquine and tumor necrosis factor (TNF) inhibitors have been found to decrease diabetes incidence in observational studies. Additionally, dapsone and sulfasalazine alter erythrocyte survival resulting in inaccurate HbA1c values. These multifaceted effects of immune modulators create a need for coordinated care between providers treating patients with diabetes to individualize medication selection and prevent hypoglycemic events. More research is needed to determine the long-term outcomes of immune modulators in patients with diabetes.
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Affiliation(s)
- Scott J Pilla
- General Internal Medicine, Johns Hopkins University, 2024 E. Monument St, Room 2-604A, Baltimore, MD, 21205, USA
| | - Amy Q Quan
- Johns Hopkins School of Medicine, 2202 E Fairmount Ave, Baltimore, MD, 21231, USA
| | - Emily L Germain-Lee
- Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Broadway, Room 583, Baltimore, MD, 801 N, USA
| | - David B Hellmann
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins, Bayview, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, Room 322, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Nestoras N Mathioudakis
- Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA.
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10
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Olivieri AN, Iafusco D, Mellos A, Zanfardino A, Mauro A, Granato C, Gicchino MF, Prisco F, Perrone L. Refractory rheumatoid factor positive polyarthritis in a female adolescent already suffering from type 1 diabetes mellitus and Hashimoto's thyroiditis successfully treated with etanercept. Ital J Pediatr 2013; 39:64. [PMID: 24124913 PMCID: PMC3853088 DOI: 10.1186/1824-7288-39-64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/06/2013] [Indexed: 11/10/2022] Open
Abstract
Type 1 diabetes mellitus may be associated with many autoimmune diseases with the common autoimmune pathogenesis. We describe the case of a girl suffering from Type 1 diabetes mellitus and autoimmune Hashimoto's thyroiditis since the childhood and, due to the onset of Juvenile Idiopathic Arthritis during adolescence, for three years practiced therapy with an anti-TNF drug, etanercept . Currently her inflammatory markers are normal, arthritis is inactive and diabetes is well controlled. During the treatment with anti-TNF drug we observed a significative reduction of insulin dose, probably due to an increased tissue sensitivity secondary to the suppression of the activity of TNF-alpha. Several clinical trials that have evaluated the effect of immunomodulatory agents in diabetic patients, especially in those with recent onset of disease, were already performed but further studies of longer duration on a larger population are needed to assess the role of biologic drugs and immunotherapy in this group of patients.
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Affiliation(s)
- Alma Nunzia Olivieri
- Department of the Woman, of the Child and of the General and Specialistic Surgery, Second University of Naples (SUN), 2, via Luigi De Crecchio, Naples 80138, Italy.
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11
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Antohe JL, Bili A, Sartorius JA, Kirchner HL, Morris SJ, Dancea S, Wasko MCM. Diabetes mellitus risk in rheumatoid arthritis: reduced incidence with anti-tumor necrosis factor α therapy. Arthritis Care Res (Hoboken) 2012; 64:215-21. [PMID: 21972198 DOI: 10.1002/acr.20657] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the association of tumor necrosis factor α (TNFα) inhibitor use and the risk of developing diabetes mellitus in a rheumatoid arthritis (RA) inception cohort. METHODS Adults diagnosed with RA between January 1, 2001, and December 31, 2009, were identified (n = 1,881). Prevalent cases of diabetes mellitus (n = 294) were excluded. Information on sociodemographic data, medical history, body mass index (BMI), laboratory measures, and medications was collected from the electronic health record. Incident diabetes mellitus was defined using the 2010 American Diabetes Association criteria or physician-established diagnosis. Time-varying Cox proportional hazards regression models were used to adjust for age, sex, race, BMI, rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), and use of nonsteroidal antiinflammatory drugs (NSAIDs), glucocorticoids, hydroxychloroquine, and methotrexate. RESULTS A total of 1,587 incident RA patients without diabetes mellitus were included. The anti-TNFα users (n = 522) had a lower median age but greater baseline BMI; maximum ESR, RF, and anti-CCP positivity; and NSAID, glucocorticoid, or methotrexate use. The median followup time for the ever and never TNFα inhibitor users was 44.9 months (interquartile range [IQR] 23.7-73.0 months) and 37.1 months (IQR 16.3-65.1 months), respectively (P < 0.001). Of the 91 patients developing diabetes mellitus, 16 were ever and 75 were never TNFα inhibitor users, yielding incidence rates of 8.6 and 17.2 per 1,000 person-years (P = 0.048), respectively. Adjusting for covariates, the hazard ratio for incident diabetes mellitus in TNFα inhibitor users was 0.49 (95% confidence interval 0.24-0.99, P = 0.049) compared to the never users. CONCLUSION In this inception RA cohort, anti-TNFα use was associated with a 51% reduction in risk of developing diabetes mellitus.
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Affiliation(s)
- Jana L Antohe
- Geisinger Medical Center, Danville, Pennsylvania 17822, USA
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12
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Development of low blood glucose readings in nine non-diabetic patients treated with tumor necrosis factor-alpha inhibitors: a case series. J Med Case Rep 2012; 6:5. [PMID: 22234148 PMCID: PMC3266185 DOI: 10.1186/1752-1947-6-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 01/10/2012] [Indexed: 12/14/2022] Open
Abstract
Introduction Treatment with various biological agents in disease states such as rheumatoid arthritis has been associated with multiple side effects. Whereas many of these are frequently reported in the literature, hypoglycemia, a possible side effect of tumor necrosis factor-alpha inhibitors, may be underpublicized. Case presentation We report nine cases of non-diabetic Caucasian women who were between 29 and 68 years of age and who developed low glucose readings after treatment with tumor necrosis factor-alpha inhibitors. We provide a more detailed discussion of existing evidence of the role of tumor necrosis factor-alpha in the pathogenesis of inflammation and its impact on glycemic equilibrium. Conclusions Physicians using tumor necrosis factor-alpha inhibitors in the treatment of various rheumatic and other autoimmune diseases should be aware of the potential for the development of glycemic disturbance in these patients. A further role of tumor necrosis factor-alpha inhibitors in the glycemic equilibrium warrants larger controlled trials in patients with and those without a history of diabetes.
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13
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Abstract
Drugs are the most frequent cause of hypoglycaemia in adults. Although hypoglycaemia is a well known adverse effect of antidiabetic agents, it may occasionally develop in the course of treatment with drugs used in everyday clinical practice, including NSAIDs, analgesics, antibacterials, antimalarials, antiarrhythmics, antidepressants and other miscellaneous agents. They induce hypoglycaemia by stimulating insulin release, reducing insulin clearance or interfering with glucose metabolism. Several drugs may also potentiate the hypoglycaemic effect of antidiabetic agents. Administration of these agents to individuals with diabetes mellitus is of most concern. Many of these drugs, and depending on clinical setting, may also induce hyperglycaemia. Drug-induced hepatotoxicity and nephrotoxicity may lead in certain circumstances to hypoglycaemia. Some drugs may also induce hypoglycaemia by causing pancreatitis. Drug-induced hypoglycaemia is usually mild but may be severe. Effective clinical management can be handled through awareness of this drug-induced adverse effect on blood glucose levels. Herein, we review pertinent clinical information on the incidence of drug-induced hypoglycaemia and discuss the underlying pathophysiological mechanisms, and prevention and management.
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Affiliation(s)
- Chaker Ben Salem
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, and Medical Intensive Care Unit, Sahloul University Hospital, Sousse, Tunisia.
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14
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Piérard GE, Piérard-Franchimont C, Szepetiuk G, Paquet P, Quatresooz P. The therapeutic potential of TNF-α antagonists for skin psoriasis comorbidities. Expert Opin Biol Ther 2010; 10:1197-208. [PMID: 20560729 DOI: 10.1517/14712598.2010.500283] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Vena GA, Vestita M, Cassano N. Can early treatment with biologicals modify the natural history of comorbidities? Dermatol Ther 2010; 23:181-93. [DOI: 10.1111/j.1529-8019.2010.01313.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wambier CG, Foss-Freitas MC, Paschoal RS, Tomazini MV, Simão JC, Foss MC, Foss NT. Severe hypoglycemia after initiation of anti-tumor necrosis factor therapy with etanercept in a patient with generalized pustular psoriasis and type 2 diabetes mellitus. J Am Acad Dermatol 2009; 60:883-5. [PMID: 19389539 DOI: 10.1016/j.jaad.2008.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 10/01/2008] [Accepted: 10/02/2008] [Indexed: 12/14/2022]
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Channual J, Wu JJ, Dann FJ. Effects of tumor necrosis factor-alpha blockade on metabolic syndrome components in psoriasis and psoriatic arthritis and additional lessons learned from rheumatoid arthritis. Dermatol Ther 2009; 22:61-73. [PMID: 19222518 DOI: 10.1111/j.1529-8019.2008.01217.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic T cell-mediated inflammatory diseases that manifest not only in the skin and joints but also in the form of cardiometabolic disturbances, which include insulin resistance, dyslipidemia, and obesity. Thus, PsO and PsA patients are predisposed to metabolic syndrome (MetS), diabetes, and cardiovascular disease. In recent years, the introduction of targeted therapy in the form of tumor necrosis factor-alpha (TNF-alpha) antagonists, such as infliximab, etanercept, and adalimumab has been an important and effective addition to the treatment armamentarium for PsO and PsA. Although TNF-alpha antagonists have produced promising results clinically in reducing cutaneous and joint manifestations of PsO and PsA, their effects on MetS components in these patients are presently unclear. This review summarizes the current limited evidence on the effects of TNF-alpha antagonists on MetS components in PsO and PsA patients and extrapolates from related literature in rheumatoid arthritis, which is also a T cell-mediated inflammatory disease, for additional information.
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Affiliation(s)
- Jennifer Channual
- School of Medicine, University of California-Irvine, Irvine, CA, USA
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Cheung D, Bryer-Ash M. Persistent hypoglycemia in a patient with diabetes taking etanercept for the treatment of psoriasis. J Am Acad Dermatol 2009; 60:1032-6. [PMID: 19217693 DOI: 10.1016/j.jaad.2008.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 12/03/2008] [Accepted: 12/04/2008] [Indexed: 02/08/2023]
Abstract
We report a patient with type 2 diabetes mellitus who, while treated with the antitumor necrosis factor-alpha blocking agent etanercept for severe plaque psoriasis, experienced persistent hypoglycemia requiring the lowering and eventual elimination of his previous insulin regimen. After 20 months of therapy on etanercept, his plaque psoriasis markedly improved, whereas both his fasting blood sugars and glycosylated hemoglobin A(1c) decreased. Hypoglycemia can be a serious side effect of etanercept in patients already on antidiabetic medications known to cause hypoglycemia, such as sulfonylureas, meglitinides, and insulin. Thus, it is important for dermatologists treating patients with diabetes and antitumor necrosis factor-alpha agents for psoriasis to be aware of potential hypoglycemia and to adjust antidiabetes therapy accordingly.
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Affiliation(s)
- Dianne Cheung
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
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Current awareness: pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008; 17:i-xvi. [PMID: 18533281 PMCID: PMC7167700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [PMID: 18533281 PMCID: PMC7167700 DOI: 10.1002/pds.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.
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