No Association Between TNF Inhibitor and Methotrexate Therapy Versus Methotrexate in Changes in Hemoglobin A1C and Fasting Glucose Among Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis Patients
February 2015 | Volume 14 | Issue 2 | Original Article | 159 | Copyright © 2015
Jashin J. Wu MD,a Christopher G. Rowan PhD,b Judith D. Bebchuk ScD,c and Mary S. Anthony PhDd
aDepartment of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
bAmerican Medical Group Association, Alexandria, VA
cDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
dAmgen Inc., Center for Observational Research, Thousand Oaks, CA
BACKGROUND: The use of tumor necrosis factor inhibitors (TNFi) has been associated with a reduced incidence of type 2 diabetes mellitus.
OBJECTIVE: To compare changes in hemoglobin A1C and fasting glucose for patients exposed to TNFi.
METHODS: In this retrospective cohort study, patients with at least 3 recorded diagnosis codes for psoriasis, psoriatic arthritis, or rheumatoid arthritis between January 1, 2004 and July 31, 2011. Patients were Kaiser Permanente Southern California members for at least 1 year prior to the index date.
RESULTS: For hemoglobin A1C, there were 344 patients in the MTX cohort, and 118 patients in the TNFi+MTX cohort. In the covariate adjusted main effects ANCOVA model, the TNFi+MTX cohort had a lower mean change in hemoglobin A1C of -0.18mg/dL (95% CI: -0.35, -0.01) compared to the MTX cohort, although the difference is small and this model was not complete as there were significant interactions. For fasting glucose, there were 524 patients in the MTX cohort, and 121 patients in the TNFi+MTX cohort. In the covariate adjusted main effects ANCOVA model, change in fasting glucose was not significantly different between groups: -0.58 mg/dL (95% CI: -5.05, 3.88) for the TNFi+MTX cohort compared to the MTX cohort, although this model was not complete as there was a significant interaction.
CONCLUSIONS: The use of TNF inhibitors with MTX was not associated with a significant difference in the change of hemoglobin A1C or fasting glucose compared to MTX alone.
J Drugs Dermatol. 2015;14(2):159-166.
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Psoriasis is a chronic skin condition affecting approximately 2-3% of the population1, 2 that is associated with an increased risk of cardiovascular diseases, including obesity,3, 4 diabetes type 2,5, 6 hypertension,5, 7 dyslipidemia,3, 7 metabolic syndrome, 2, 8 and other cardiovascular risk factors. Psoriatic arthritis is a seronegative inflammatory arthritis condition that can accompany psoriasis or present separately. The prevalence of psoriatic arthritis among psoriasis patients may be as low as 11% 9 or as high as 30%.10 Rheumatoid arthritis is an inflammatory autoimmune disease of the joints affecting about 0.5-1% of the adult population worldwide11 and is also associated with increased risk of cardiovascular diseases.12-14
Several systemic therapeutic options are available for the treatment of these inflammatory conditions. Treatment effects on comorbidities such as cardiovascular disease have been described recently. The use of tumor necrosis factor (TNF) inhibitors for psoriasis is associated with a significant reduction in myocardial infarction (MI) incidence and risk,15, 16 and the use of TNF inhibitors for psoriasis, psoriatic arthritis, and rheumatoid arthritis is associated with a lower risk of diabetes. 17 However, some reports show that use of TNF inhibitors is not associated with changes in individual markers (such as lipids) for cardiovascular diseases.18
The primary objective of this study was to assess changes in metabolic factors for patients with psoriasis, psoriatic arthritis, or rheumatoid arthritis exposed to a TNFi plus methotrexate (TNFi+MTX) compared to patients exposed to methotrexate (MTX) therapy alone.