Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Tumor Necrosis Factor- Inhibitors and Reduced Risk of Developing Diabetes in Patients with Rheumatoid Arthritis.
Antohe1, Jana, Bili1, Androniki, Sartorius2, Jennifer A., Kirchner2, H. Lester, Morris1, Stephanie J., Dancea1, Sorina, Wasko3, Mary Chester
Tumor necrosis factor-alpha (TNF-a) inhibitors may improve insulin sensitivity and thus would be expected to reduce the risk of diabetes mellitus (diabetes) in patients with rheumatoid arthritis (RA). This study examined the association of TNF-a inhibitor use and the risk of developing diabetes in an RA inception cohort in a rural, tertiary health system using Electronic Health Records (EHR).
All adult individuals diagnosed with RA between 1/1/2001 3/31/2008 were identified (n=1539). RA was defined as ICD-9 code 714.0 at >= 2 outpatient encounters with a rheumatologist, and diagnosis was validated against the American College of Rheumatology criteria by manual review of 100 random charts (97% concordance). Prevalent cases of diabetes, defined as 1 or more outpatient visits with ICD-9 250, a non-fasting blood glucose >= 200 mg/dl, hemoglobin A1C >= 7, or a hypoglycemic medication order, were excluded (n=252). Information on demographic data, medical history, body mass index (BMI), laboratory measures and medications were collected at office visits. Patients were classified as ever (n=352) or never (n=935) users of a TNF-a inhibitor (etanercept, adalimumab, or infliximab). Incident diabetes cases were identified using 2010 American Diabetes Association criteria. Time-varying Cox Proportional Hazard regression models were used to adjust for gender, age, race, hypertension, BMI, positive rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate, C-reactive protein (CRP), non-steroidal anti-inflammatory drug (NSAID), glucocorticoid, hydroxychloroquine and methotrexate use. Medication use was considered continuous for lapses <= 90 days.
1287 non-diabetic incident RA patients were included in the analysis. Patients were predominantly women (63%), and 97% were Caucasian, with median age of 61 y and BMI 28.6 kg/m2. RF and anti-CCP were positive in 80% and 53%, respectively. Patients in the ever TNF-a inhibitor use group had a higher median BMI and CRP levels and were more likely to have positive RF and anti-CCP and to have taken NSAIDs, glucocorticoids or methotrexate. Median follow-up time (last visit or diabetes diagnosis date) for the ever- and never-TNF-a inhibitor users was 34.7 months and 23.1 months, respectively (p<.001).The median duration of TNF-a inhibitor exposure was 33.5 months. Of the 56 cases developing diabetes during observation, 13 wereever and 43 were never TNF-a inhibitor users, yielding incidence rates of 10.5 and 22.0 per 1000 person-years (p=0.019), respectively. Adjusting for covariates, the hazard ratio for incident diabetes among TNF-a inhibitor users was 0.40 (95% confidence interval 0.160.98, p=0.046) compared to non-users.
In this inception RA cohort, the use of TNF-a inhibitors was associated with a 60% reduction in risk of developing diabetes after controlling for confounders. These findings need to be confirmed by additional studies in this group of patients at high risk of cardiovascular disease.
To cite this abstract, please use the following information:
Antohe, Jana, Bili, Androniki, Sartorius, Jennifer A., Kirchner, H. Lester, Morris, Stephanie J., Dancea, Sorina, et al; Tumor Necrosis Factor- Inhibitors and Reduced Risk of Developing Diabetes in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1442