TNF Inhibitors Shown to Reduce Diabetes Risk in RA Patients

SAN DIEGO, CA—Daniel H. Solomon, MD, MPH, concluded that patients with rheumatoid arthritis (RA) treated with tumor necrosis factor (TNF) inhibitors had a reduced risk for development of diabetes, as presented at the 2013 ACR/ARHP Annual Meeting.

Some studies indicated that certain DMARDs might be associated with a reduced risk of diabetes due to its effect on inflammation. Dr. Solomon and his team assessed the association between DMARD exposure and incident diabetes in a large multicenter, observational cohort of RA patients. The enrolled patients were from the longitudinal multicenter cohort in CORRONA.

Five DMARD categories were defined:

1)      TNF inhibitors, including combinations with non-biologic (nb) DMARDs

2)      Other biologic (b) DMARDs, including combinations with nbDMARDs 

3)      Methotrexate, without concomitant bDMARDS or hydroxychloroquine

4)      Hydroxychloroquine without concomitant bDMARDs or methotrexate, and

5)      Other nbDMARDs without concomitant TNF inhibitors, methotrexate or hydroxychloroquine

A total of 21,775 eligible treatment regimens were identified.  The mean duration of the treatment regimens ranged from 1.5 – 2.4 years, and 82 incident cases of diabetes of interest were confirmed.

The diabetes incidence rates for the five defined categories are as follows: TNF inhibitors (1.46, 95% CI [1.03, 2.00]); Other bDMARDS (1.53, 95% CI [0.51, 3.63]); Methotrexate (2.08, 95% CI [1.45, 2.29]), Hydroxychloroquine (1.29, 95% CI [0.43, 3.07]); and Other nbDMARDs (3.07, 95% CI [1.37, 6.03]).

“Diabetes development was significantly reduced in patients receiving TNF inhibitors compared to patients receiving other non-biologic DMARDS,” noted Dr. Solomon. “Use of hydroxychloroquine, methotrexate, and other biologic DMARDs also trended toward a reduced risk, but confidence intervals did not exclude the null.” In addition, higher steroid dosages were associated with an increased risk of diabetes in separate models.  

After adjusting models for variables such as body mass index, disease activity, and steroid use, TNF inhibitor use demonstrated a reduced risk for the development of diabetes in patients with RA.  “This study supports a potential tailoring of RA treatment in individuals at high risk of diabetes.”