AB0671 IMPROVING METABOLIC OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS USING BIOLOGICS
Authors: D. X. Xibille Friedmann, Y. Mujica-Faife, E. Alcántara-Alonso, S. M. Carrillo Vazquez
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Treatment with biologic disease modifying drugs (bDMARDs) have improved disease activity and functional outcomes in patients with Rheumatoid Arthritis (RA). In Mexico the high prevalence of Diabetes means that many RA patients have metabolic comorbidities that may be influenced by the type of therapeutic strategy they employ, making access to safe and effective treatment a priority. <h3>Objectives:</h3> To determine the influence of the type of therapeutic strategy on metabolic outcomes in patients with RA. <h3>Methods:</h3> Patients classified with RA (ACR/EULAR 2010) and pre-diabetes (pDM; ADA criteria) from two hospital centers in Mexico, one in Mexico City and the other in the state of Morelos, were included into the study. Patients were divided into two groups, those receiving bDMARD and those receiving only conventional synthetic (cs)DMARDs. Disease activity was determined using the 28 joint disease activity score (DAS28, using C-reactive protein [CRP]). The clinical evaluation of patients was carried out by two rheumatologists, one at each center. Basic metabolic parameters (part of the patients' routine follow-up) analyzed were glycosylated hemoglobin (HbA1c) as well as high density (HDL), low density lipoprotein (LDL) cholesterol and triglycerides. Student's T and χ2 tests were used for comparisons between groups; statistical significance was set as p&lt;0.05. Data was analyzed using Python with Matplotlib and ChatGPT4. <h3>Results:</h3> We included a total of 80 patients, all of whom had pDM; most of the patients were women (95%) and we divided patients into two groups, those with access to biologic therapy and those without. 66 patients received bDMARD while 14 only were treated with csDMARD, mainly methotrexate (MTX; 7.5-20 mg/week). Patients receiving prednisone did so at a dose of ≤10 mg/day and those taking MTX received folate supplementation. Patients with bDMARD received anti-TNFa inhibitors (53.1%), Tocilizumab (27.2%), Rituximab (21%) and Abatacept (12.3%). In the group that only was treated with csDMARD mean age was 53 years (SD 9.6) while patients that received bDMARD had a mean 58.9 years (SD 9.2); median time since onset of RA was 10.5 years (8.5-20.2) and 16 years (7.5-25) in the bDMARD group. There were no statistically significant differences in weight and body mass index between the groups. As expected, median DAS28 was lower in patients receiving bDMARD (mean DAS28 bDMARD 2.34; 1.6-3.1 vs csDMARD 3.3; 2.8-3.9, SD, p&lt;0.0002). Median CRP was also lower in the bDMARD group (0.4; 0.22 vs. 7.5; 2.7-17.3, p&lt;0.0001). Although no significant differences in glucose levels were observed between groups (csDMARD median 106.8; 5.84-6.11 vs. bDMARD 105.6; 97-111.5), median HbA1c was significantly lower in patients receiving bDMARD (5.8; 5.6-6 vs. 5.99; 5.8-6.1, p 0.0178) (Figure 1), although mean LDL levels were significantly higher in patients receiving bDMARD (140.5; SD 75.6 vs. 114.8; SD 28.9, p&lt;0.0001). HDL and triglyceride levels showed no difference between groups. <h3>Conclusion:</h3> Patients with RA have a higher risk of abnormal glucose metabolism. Access to advanced therapies certainly improves clinical and functional scores in RA but may also play a role in improving metabolic outcomes in patients at risk or who already have a comorbidity such as diabetes. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> We wish to thank all of the personnel and patients at both the Hospital Regional 1 de Octubre and the Hospital General de Cuernavaca. <h3>Disclosure of Interests:</h3> Daniel Xavier Xibille Friedmann Astra Zeneca, GSK, Lilly, Astra Zeneca, Astra Zeneca, GSK, Lilly, Yadisley Mujica-Faife: None declared, Estefanía Alcántara-Alonso: None declared, Sandra Miriam Carrillo Vazquez Astra Zeneca, Jannsen, Novartis, Lilly, Astra Zeneca, Jannsen, Novartis, Lilly.