Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Systemic inflammation, insulin resistance, and endothelial dysfunction were implicated in the development of cardiovascular disease in rheumatoid arthritis (RA) [1-3]. Since insulin resistance can promote endothelial dysfunction and IL-6 blockade yields a rapid improvement of endothelial function , we aimed to assess whether IL-6 blockade may also result in a reduction of insulin serum levels and improvement of insulin resistance in patients with RA.
Methods: 50 Spanish patients on treatment with anti-IL-6 monoclonal antibody-Tocilizumab who fulfilled the 2010 classification criteria for RA  were recruited. Patients with diabetes mellitus or plasma glucose > 110 mg/dl were excluded. Fasting blood samples were taken for determination of plasma glucose and serum insulin levels immediately prior to (time 0) and after (time 60 minutes) Tocilizumab infusion. Insulin resistance was assessed by the homeostasis model assessment for insulin resistance (HOMA) and insulin sensitivity was evaluated by the quantitative insulin sensitivity check index (QUICKI).
Results: A marked reduction in the serum insulin levels was observed following Tocilizumab infusion (mean ± standard deviation (SD): 10.60 ± 5.80 µU/ml versus 7.61 ± 5.08 µU/ml, p˂0.0001). In addition, a decrease in the insulin/glucose index was observed in patients with RA after Tocilizumab dose (mean ± SD: 0.12 ± 0.06 versus 0.08 ± 0.05, p˂0.0001). Furthermore, a significant improvement of insulin resistance (HOMA: mean ± SD: 2.61 ± 2.05 versus 1.65 ± 1.14, p=0.0003) and insulin sensitivity (QUICKI: mean ± SD: 0.34 ± 0.003 versus 0.37 ± 0.04, p˂0.0001) was found following Tocilizumab infusion.
Conclusion: Our study confirms a rapid beneficial effect of Tocilizumab on insulin resistance and insulin sensitivity in RA patients treated with this drug. It may support the long-term use of drugs that act blocking IL-6 function to reduce the mechanisms implicated in the development of atherosclerosis in patients with RA.
 Gonzalez-Juanatey et al. Am J Med 2003; 114: 647-52.  López-Mejías R et al. Autoimmun Rev 2016; 15: 1013-30.  Gonzalez-Gay MA et al. Autoimmun Rev 2004; 3: 301-4.  Protogerou et al. Atherosclerosis 2011; 219: 734-6.  Aletaha D. et al. Arthritis Rheum 2010; 62: 2569-81.
RL-M is supported by the Miguel Servet I programme of the Spanish Ministry of Economy and Competitiveness through the grant CP16/00033. FG is recipient of a Sara Borrell postdoctoral fellowship from the “Instituto Carlos III de Salud” at the Spanish Ministry of Health (Spain) (CD15/00095). SR-M is supported by funds from the RETICS Program (RIER) (RD16/0012/0009).
To cite this abstract in AMA style:López-Mejías R, Genre F, Remuzgo-Martínez S, Ubilla B, Mijares V, Calvo-Alen J, Llorca J, Castañeda S, González-Gay MA. Beneficial Effect of Anti-IL-6 Blockade on Insulin Resistance and Insulin Sensitivity in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/beneficial-effect-of-anti-il-6-blockade-on-insulin-resistance-and-insulin-sensitivity-in-patients-with-rheumatoid-arthritis/. Accessed September 24, 2021.
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