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Improvement in insulin resistance is greater when infliximab is added to methotrexate during intensive treatment of early rheumatoid arthritis-results from the IDEA study.
- Source :
-
Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2016 Dec; Vol. 55 (12), pp. 2181-2190. Date of Electronic Publication: 2016 Sep 16. - Publication Year :
- 2016
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Abstract
- Objectives: To determine the change in established biomarkers of cardiovascular (CV) risk, namely, total cholesterol/high-density lipoprotein cholesterol ratio (TC/HDL-C), N-terminal pro-brain natriuretic peptide (NT-proBNP) and insulin resistance (IR) in patients with early RA treated with two different treat-to-target strategies.<br />Methods: Fasting glucose, lipids, insulin and NT-proBNP were measured at baseline, weeks 26 and 78 in 79 DMARD-naïve RA patients, free of CV disease, as part of a double-blind randomized controlled trial of MTX with either infliximab (IFX) or methylprednisolone as induction therapy. Homeostasis model assessment-estimated IR (HOMA-IR) (glucose*insulin/405) was used to measure IR. Multiple imputation was employed, and linear regression analyses were adjusted for baseline values.<br />Results: Changes in DAS44-CRP did not differ between the treatment arms at weeks 26 and 78. Mean TC/HDL-C, HOMA-IR and NT-proBNP improved in both groups at weeks 26 and 78, although change in NT-proBNP was not statistically significant at week 78. Changes in TC/HDL-C and NT-proBNP were similar between treatment arms, but HOMA-IR values in the IFX + MTX arm were 42% lower than those treated with MTX + methylprednisolone at week 78 (P = 0.003); the difference remained significant after adjustment for baseline BMI, ACPA positivity, smoking status and intramuscular glucocorticoid use (P = 0.007).<br />Conclusion: When implementing a treat-to-target approach, treatment of early RA was associated with improvement in TC/HDL-C, HOMA-IR and NT-proBNP, and a greater long-term improvement in HOMA-IR was seen in those treated with IFX.<br />Trial Registration: EU Clinical Trials Register, http://www.clinicaltrialsregister.eu, Eudract-2005-005013-37; ISRTCNregisrty, http://www.isrctn.com, ISRCTN48638981.<br /> (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Adult
Aftercare
Aged
Biomarkers metabolism
Blood Glucose drug effects
Blood Glucose metabolism
Cardiovascular Diseases diagnosis
Cardiovascular Diseases etiology
Cholesterol, HDL metabolism
Diabetes Complications complications
Double-Blind Method
Early Diagnosis
Female
Glucocorticoids therapeutic use
Humans
Insulin metabolism
Lipid Metabolism drug effects
Male
Methylprednisolone therapeutic use
Middle Aged
Natriuretic Peptide, Brain metabolism
Peptide Fragments metabolism
Risk Factors
Surveys and Questionnaires
Treatment Outcome
Young Adult
Antirheumatic Agents therapeutic use
Arthritis, Rheumatoid drug therapy
Infliximab therapeutic use
Insulin Resistance physiology
Methotrexate therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1462-0332
- Volume :
- 55
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Rheumatology (Oxford, England)
- Publication Type :
- Academic Journal
- Accession number :
- 27638812
- Full Text :
- https://doi.org/10.1093/rheumatology/kew306