Severe hypoglycemia after initiation of anti–tumor necrosis factor therapy with etanercept in a patient with generalized pustular psoriasis and type 2 diabetes mellitus

Wambier, Carlos Gustavo; Foss‐Freitas, Maria Cristina; Paschoal, Renato Soriani; Tomazini, Marília Vannuchi; Simão, João Carlos Lopes; Foss, Milton César; Foss, Norma Tiraboschi

doi:10.1016/j.jaad.2008.10.009

Cited by 13 publications

(6 citation statements)

References 5 publications

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“…21 These results are corroborated by cases of severe hypoglycaemia reported in diabetic patients treated with anti-TNF-a for psoriasis. 2,22 Although we have not studied insulin, the lack of decrease in FBG and HbA1C after 24 weeks of systemic treatment (including in the BT subgroup) observed in our study does not support a positive effect of the systemic treatments of psoriasis on glycemic levels of treated patients. A prospective study on 12 patients with PsO and high risk of diabetes mellitus reported similar conclusions with no statistically significant changes in insulin and insulinoresistance after 2 weeks of treatment with etanercept.…”

Section: Discussioncontrasting

confidence: 61%

“…A study on nine patients with PsO has showed that 24 weeks of etanercept treatment reduced the insulin resistance . These results are corroborated by cases of severe hypoglycaemia reported in diabetic patients treated with anti‐TNF‐α for psoriasis . Although we have not studied insulin, the lack of decrease in FBG and HbA1C after 24 weeks of systemic treatment (including in the BT subgroup) observed in our study does not support a positive effect of the systemic treatments of psoriasis on glycemic levels of treated patients.…”

Section: Discussionmentioning

confidence: 67%

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Impact of systemic treatment of psoriasis on inflammatory parameters and markers of comorbidities and cardiovascular risk: results of a prospective longitudinal observational study

Montaudié¹,

Albert-Sabonnadière²,

Acquacalda³

et al. 2013

Acad Dermatol Venereol

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We observed a high frequency of disturbance of inflammatory parameters and markers of comorbidities and CV risk in a population with moderate to severe PsO and PsA, most of which were not detected before. A significant decrease in inflammatory parameters was noted after the introduction of systemic therapy, while other parameters remained unaffected by the treatment, except the weight that increased under biologics therapies.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 67%

Impact of systemic treatment of psoriasis on inflammatory parameters and markers of comorbidities and cardiovascular risk: results of a prospective longitudinal observational study

Montaudié¹,

Albert-Sabonnadière²,

Acquacalda³

et al. 2013

Acad Dermatol Venereol

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“…An infusion of human recombinant TNFα has been shown to increase [53], as well as decrease [54], insulin sensitivity in healthy volunteers. Symptomatic hypoglycaemia has been reported in patients with diabetes and RA or psoriasis who were treated with etanercept [55][56][57][58]. Properly designed clinical trials testing the effect of biologic anti-inflammatory drugs inhibiting TNF (e.g.…”

Section: Discussionmentioning

confidence: 99%

Interleukin-6 receptor blockade or TNFα inhibition for reducing glycaemia in patients with RA and diabetes: post hoc analyses of three randomised, controlled trials

et al. 2020

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Background Diabetes is common in patients with rheumatoid arthritis (RA). Interleukin (IL)-6 is implicated in both the pathogenesis of RA and in glucose homeostasis; this post hoc analysis investigated the effects of IL-6 receptor vs. tumour necrosis factor inhibition on glycosylated haemoglobin (HbA1c) in patients with RA with or without diabetes. Methods Data were from two placebo-controlled phase III studies of subcutaneous sarilumab 150/200 mg q2w + methotrexate or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and a phase III monotherapy study of sarilumab 200 mg q2w vs. adalimumab 40 mg q2w. Patients with diabetes were identified by medical history or use of antidiabetic medication (patients with HbA1c ≥ 9% were excluded from all three studies). HbA1c was measured at baseline and weeks 12/24. Safety and efficacy were assessed in RA patients with or without diabetes. Results Patients with diabetes (n = 184) were older, weighed more and exhibited higher RA disease activity than patients without diabetes (n = 1928). Regardless of diabetes status, in patients on background csDMARDs, least squares (LS) mean difference (95% CI) in change from baseline in HbA1c for sarilumab 150 mg/200 mg vs. placebo at week 24 was − 0.28 (− 0.40, − 0.16; nominal p < 0.0001) and − 0.42 (− 0.54, − 0.31; nominal p < 0.0001), respectively. Without csDMARDs, LS mean difference for sarilumab 200 mg vs. adalimumab 40 mg at week 24 was − 0.13 (− 0.22, − 0.04; nominal p = 0.0043). Greater reduction in HbA1c than placebo or adalimumab was observed at week 24 with sarilumab in patients with diabetes and/or baseline HbA1c ≥ 7%. There was no correlation between baseline/change from baseline in HbA1c and baseline/change from baseline in C-reactive protein, 28-joint Disease Activity Score, or haemoglobin, nor between HbA1c change from baseline and baseline glucocorticoid use. Medical history of diabetes or use of diabetes treatments had limited impact on safety and efficacy of sarilumab and was consistent with overall phase III findings in patients with RA. Conclusions In post hoc analyses, sarilumab was associated with a greater reduction in HbA1c than csDMARDs or adalimumab, independent of sarilumab anti-inflammatory effects. Prospective studies are required to further assess these preliminary findings. Trial registration ClinTrials.gov NCT01061736: date of registration February 03, 2010; ClinTrials.gov NCT01709578: date of registration October 18, 2012; ClinTrials.gov NCT02332590: date of registration January 07, 2015.

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“…This finding pointed to a salutary effect on glucose metabolism [12]. In a similar case, a 51-year-old woman who had type II diabetes and who was hospitalized with erythrodermic psoriasis experienced hypoglycemia of as low as 27 mg/dL and convulsions after only seven hours of initiating etanercept, and insulin therapy was discontinued to maintain normal glycemic control [13]. …”

Section: Discussionmentioning

confidence: 99%

Development of low blood glucose readings in nine non-diabetic patients treated with tumor necrosis factor-alpha inhibitors: a case series

2012

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IntroductionTreatment with various biological agents in disease states such as rheumatoid arthritis has been associated with multiple side effects. Whereas many of these are frequently reported in the literature, hypoglycemia, a possible side effect of tumor necrosis factor-alpha inhibitors, may be underpublicized.Case presentationWe report nine cases of non-diabetic Caucasian women who were between 29 and 68 years of age and who developed low glucose readings after treatment with tumor necrosis factor-alpha inhibitors. We provide a more detailed discussion of existing evidence of the role of tumor necrosis factor-alpha in the pathogenesis of inflammation and its impact on glycemic equilibrium.ConclusionsPhysicians using tumor necrosis factor-alpha inhibitors in the treatment of various rheumatic and other autoimmune diseases should be aware of the potential for the development of glycemic disturbance in these patients. A further role of tumor necrosis factor-alpha inhibitors in the glycemic equilibrium warrants larger controlled trials in patients with and those without a history of diabetes.

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Severe hypoglycemia after initiation of anti–tumor necrosis factor therapy with etanercept in a patient with generalized pustular psoriasis and type 2 diabetes mellitus

Cited by 13 publications

References 5 publications

Impact of systemic treatment of psoriasis on inflammatory parameters and markers of comorbidities and cardiovascular risk: results of a prospective longitudinal observational study

Impact of systemic treatment of psoriasis on inflammatory parameters and markers of comorbidities and cardiovascular risk: results of a prospective longitudinal observational study

Interleukin-6 receptor blockade or TNFα inhibition for reducing glycaemia in patients with RA and diabetes: post hoc analyses of three randomised, controlled trials

Development of low blood glucose readings in nine non-diabetic patients treated with tumor necrosis factor-alpha inhibitors: a case series

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