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Effects of Tumour Necrosis Factor Antagonists on Insulin Sensitivity/Resistance in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Burska AN, Sakthiswary R, Sattar N - PLoS ONE (2015)

Bottom Line: There was statistically significant reduction in HOMA index in six out of eight studies and four reported significant increment in QUICKI.The pooled analysis revealed significant reduction in HOMA [SDM-0.148, 95%CI[-0.278 to -0.017], p=0.026] and increment in QUICKI [SDM 0.312, 95%CI[0.019 to 0.606], p=0.037] with TNFi.There is emerging evidence to support that TNFi therapy improves IS and reduces IR in RA.

View Article: PubMed Central - PubMed

Affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.

ABSTRACT

Objective: Beyond the joints, TNFi (tumour necrosis factor inhibitor) therapy may confer systemic benefits in rheumatoid arthritis (RA). Several studies have investigated the role of TNFi on insulin resistance/sensitivity (IR/IS). This question is of general interest given the emerging evidence linking inflammation and insulin resistance. The main aim of this review was to summarise the published data and to determine the effects of TNFi on IR/IS.

Methods: We searched the PubMed and ISI Web of Knowledge databases for studies which examined the effects of TNFi on IR/IS. The studies were assessed independently by two reviewers according to a pre-specified protocol. The data on Homeostatic Model Assessment for Insulin resistance (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI) were pooled and reported as standard difference in means (SDM) with 95% confidence interval (CI) using a random-effects model.

Results: A total of eight studies with 260 subjects met the selection criteria. The duration of the studies was from 8 weeks to 12 months. There was statistically significant reduction in HOMA index in six out of eight studies and four reported significant increment in QUICKI. The pooled analysis revealed significant reduction in HOMA [SDM-0.148, 95%CI[-0.278 to -0.017], p=0.026] and increment in QUICKI [SDM 0.312, 95%CI[0.019 to 0.606], p=0.037] with TNFi.

Conclusion: There is emerging evidence to support that TNFi therapy improves IS and reduces IR in RA. Further, well conducted trials are needed to determine if such effects translate to lower incidence of diabetes in RA or other autoimmune conditions on biologic therapy.

No MeSH data available.


Related in: MedlinePlus

Funnel plots (A) for HOMA from 8 selected studies and (B) for QUICKI from 4 selected studies evaluating effects of TNFi on IR/IS.
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pone.0128889.g002: Funnel plots (A) for HOMA from 8 selected studies and (B) for QUICKI from 4 selected studies evaluating effects of TNFi on IR/IS.

Mentions: Data were pooled using a random effects model for a more conservative but precise estimate of the effects of TNF antagonist on IR/IS. This model allows for heterogeneity across the studies[17]. The data on the outcome of TNF antagonist therapy versus controls were expressed as standard difference in means (SDM) with 95% confidence intervals (CIs). Comprehensive Meta-analysis software version 2.0 was used to analyse the data and generate the Forest plots of the pooled data. Egger’s test was used to evaluate publication bias for the meta-analysis of the HOMA and QUICKI indices Fig 2).


Effects of Tumour Necrosis Factor Antagonists on Insulin Sensitivity/Resistance in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.

Burska AN, Sakthiswary R, Sattar N - PLoS ONE (2015)

Funnel plots (A) for HOMA from 8 selected studies and (B) for QUICKI from 4 selected studies evaluating effects of TNFi on IR/IS.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482317&req=5

pone.0128889.g002: Funnel plots (A) for HOMA from 8 selected studies and (B) for QUICKI from 4 selected studies evaluating effects of TNFi on IR/IS.
Mentions: Data were pooled using a random effects model for a more conservative but precise estimate of the effects of TNF antagonist on IR/IS. This model allows for heterogeneity across the studies[17]. The data on the outcome of TNF antagonist therapy versus controls were expressed as standard difference in means (SDM) with 95% confidence intervals (CIs). Comprehensive Meta-analysis software version 2.0 was used to analyse the data and generate the Forest plots of the pooled data. Egger’s test was used to evaluate publication bias for the meta-analysis of the HOMA and QUICKI indices Fig 2).

Bottom Line: There was statistically significant reduction in HOMA index in six out of eight studies and four reported significant increment in QUICKI.The pooled analysis revealed significant reduction in HOMA [SDM-0.148, 95%CI[-0.278 to -0.017], p=0.026] and increment in QUICKI [SDM 0.312, 95%CI[0.019 to 0.606], p=0.037] with TNFi.There is emerging evidence to support that TNFi therapy improves IS and reduces IR in RA.

View Article: PubMed Central - PubMed

Affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.

ABSTRACT

Objective: Beyond the joints, TNFi (tumour necrosis factor inhibitor) therapy may confer systemic benefits in rheumatoid arthritis (RA). Several studies have investigated the role of TNFi on insulin resistance/sensitivity (IR/IS). This question is of general interest given the emerging evidence linking inflammation and insulin resistance. The main aim of this review was to summarise the published data and to determine the effects of TNFi on IR/IS.

Methods: We searched the PubMed and ISI Web of Knowledge databases for studies which examined the effects of TNFi on IR/IS. The studies were assessed independently by two reviewers according to a pre-specified protocol. The data on Homeostatic Model Assessment for Insulin resistance (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI) were pooled and reported as standard difference in means (SDM) with 95% confidence interval (CI) using a random-effects model.

Results: A total of eight studies with 260 subjects met the selection criteria. The duration of the studies was from 8 weeks to 12 months. There was statistically significant reduction in HOMA index in six out of eight studies and four reported significant increment in QUICKI. The pooled analysis revealed significant reduction in HOMA [SDM-0.148, 95%CI[-0.278 to -0.017], p=0.026] and increment in QUICKI [SDM 0.312, 95%CI[0.019 to 0.606], p=0.037] with TNFi.

Conclusion: There is emerging evidence to support that TNFi therapy improves IS and reduces IR in RA. Further, well conducted trials are needed to determine if such effects translate to lower incidence of diabetes in RA or other autoimmune conditions on biologic therapy.

No MeSH data available.


Related in: MedlinePlus