Background/Purpose: Rheumatoid arthritis (RA) and diabetes mellitus (DM) are associated with inflammation. Abatacept has been reported to be effective for type 1 diabetes. We aimed to investigate the influence of tumor necrosis factor inhibitors (TNFi) and abatacept (ABT) on the glucose metabolism of patients with RA.

Methods: Patients with RA treated with TNFi or ABT from 2008 to 2018 were studied based on the All Showa University of RA (ASHURA) database. The association between glycosylated hemoglobin (HbA1c) level reduction and treatment was evaluated. Of 629 patients treated with these biologic agents, 159 with available HbA1c medical records were included (TNFi, n = 111; ABT, n = 48). The following background factors were investigated: age; sex; type of biological disease-modifying antirheumatic drugs (bDMARDs); dosage of methotrexate (MTX) and prednisolone (PSL); usage of conventional synthetic DMARD and nonsteroidal anti-inflammatory drugs; body mass index (BMI); smoking history; HbA1c; presence or absence of hypertension and dyslipidemia; and serum creatinine, C-reactive protein, and matrix metalloproteinase-3 levels. We also used the simplified disease activity index (SDAI) to evaluate RA disease activity. Propensity was calculated based on age; sex; BMI; smoking history; PSL dosage; MTX dosage; SDAI; creatinine; estimated glomerular filtration rate; presence or absence of diabetes, hypertension, and dyslipidemia; and HbA1c, and 44 patients in each group were extracted by propensity score matching. The primary endpoint was HbA1c levels before, and after 6 months and 1 year, which was determined using the repeated-measures analysis of variance (ANOVA).

Results: The HbA1c level decreased from 5.9 ± 0.79 to 5.7 ± 0.29 and 6.0 ± 2.20 in the TNFi group and from 5.9 ± 0.66 to 5.8 ± 0.00 and 5.8 ± 0.64 in the ABT group before treatment and after 6 months and 1 year, respectively. No interaction was observed among the groups. A significant difference was not observed among the groups (p = 0.76) and even during the treatment period (p = 0.85) by repeated-measures ANOVA.

Conclusion: Our study suggests that neither ABT nor TNF treatment may affect normal HbA1c levels in patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-abatacept-and-tumor-necrosis-factor-inhibitor-on-the-normal-glycosylated-hemoglobin-level-in-patients-with-rheumatoid-arthritis/