Background/Purpose:

Poor control of glycated hemoglobic A1c (HbA1c) worsens prognosis for diabetes mellitus and various complicated diseases. Corticosteroids exacerbate poor HbA1c control. This study, investigated the effects of biological disease-modifying antirheumatic drugs (bDMARDs) on HbA1c control among patients with RA, as it has not been examined before.

Methods: In total, 632 patients with RA from the All Showa University of RA database (ASHURA) was used for our study. The following background factors were investigated: age; gender,; type of bDMARD; dosage of methotrexate and prednisolone (PSL); usage of conventional synthetic DMARD and nonsteroidal anti-inflammatory drugs; body mass index; smoking history; HbA1c; presence or absence of hypertension and dyslipidemia; and levels of serum creatinine, C reactive protein, and matrix metalloproteinase-3. We also used the simplified disease activity index (SDAI) and health assessment questionnaire (HAQ) to evaluate RA disease activity and activities of daily living, respectively. Poor HbA1c control was defined as HbA1c 6.0; accordingly, we divided the patients into good and poor HbA1c control groups. Primary and secondary failures, adverse drug events, missing data, and patients who moved or had care withdrawn were excluded. SDAI and PSL dosage were the primary and secondary endpoints, respectively. Repeated measures analysis of variance (ANOVA) evaluated the HAQ scores before treatment and 1 year later.

Results:

Of 632 patients, 296 patients enrolled in this study. The SDAI was from 27.7 ± 15.6 to 7.1 ± 8.0 in the poor HbA1c control group (n = 83) and from 22.9 ± 14.0 to 6.3 ± 7.6 in the good HbA1c control group (n = 213). There was no interaction between the groups. Repeated measures ANOVA showed a significant difference between the groups (p = 0.011) and during the treatment period (p = 0.001). PSL dosage was from 3.5 ± 3.6 (mg/day) to 2.2 ± 3.0 in the poor HbA1c control group and from 2.3 ± 3.0 to 1.6 ± 3.6 in the good HbA1c control group. A significant difference was observed between the groups (p = 0.007) and during the treatment period (p = 0.001). Notably, there was no significant difference in HAQ. No patient reported HbA1c increasing by 1.0 or more during 1 year.

Conclusion:

Results showed that bDMARD therapy reduced RA disease activity and PSL dosage in both groups. Therefore, we recommend bDMARD treatment for RA regardless of good or poor HbA1c control

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-biologic-drugs-on-prognosis-of-rheumatoid-arthritis-among-patients-with-poor-glycated-hemoglobic-a1c-hba1c-control/