Effects of tumour necrosis factor antagonists on insulin sensitivity/resistance in rheumatoid arthritis: A systematic review and meta-analysis

Agata N. Burska, Sakthiswary Rajalingham, Naveed Sattar

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish
Article numbere0128889
JournalPLoS One
Volume10
Issue number6
DOIs
Publication statusPublished - 25 Jun 2015

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rheumatoid arthritis
tumor necrosis factors
systematic review
meta-analysis
insulin resistance
Insulin Resistance
Meta-Analysis
antagonists
Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Insulin
confidence interval
therapeutics
Confidence Intervals
Medical problems
selection criteria
joints (animal)
Biological Therapy
diabetes
inflammation

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Effects of tumour necrosis factor antagonists on insulin sensitivity/resistance in rheumatoid arthritis : A systematic review and meta-analysis. / Burska, Agata N.; Rajalingham, Sakthiswary; Sattar, Naveed.

In: PLoS One, Vol. 10, No. 6, e0128889, 25.06.2015.

Research output: Contribution to journalArticle

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