Sarilumab Plus DMARDs: Effects on Glycemic Control in Comorbid RA and Diabetes

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Sarilumab is a human monoclonal antibody directed against interleukin-6Rɑ.
Sarilumab is a human monoclonal antibody directed against interleukin-6Rɑ.
The following article features coverage from ACR 2017 in San Diego, California. Click here to read more of Rheumatology Advisor's conference coverage.

San Diego – A combination of sarilumab and disease-modifying antirheumatic drugs (DMARDs) administered for 24 weeks was shown to effectively reduce fasting glucose and glycosylated hemoglobin (HbA1c) in patients with rheumatoid arthritis (RA), with or without diabetes, in a study presented at the American College of Rheumatology 2017 Annual Meeting, held November 3-8 in San Diego, California.

The efficacy of sarilumab (150 mg or 200 mg every 2 weeks), a human monoclonal antibody against interleukin-6Rɑ for the treatment of RA, was assessed in 3 clinical trials: MOBILITY, TARGET, and MONARCH (ClinicalTrials.gov identifiers: NCT01061736, NCT01709578, and NCT02332590, respectively). During the study period, investigators collected patient data from the placebo-controlled TARGET and MOBILITY trials to examine the blood sugar-lowering effects of sarilumab plus DMARDs in patients with RA and diabetes (n=179) or with RA but without diabetes (n=1803).

At baseline, patients with diabetes vs those without had a higher mean body weight (84.8±21.4 vs 74.6±18.8) and had a body mass index ≥30 kg/m2 (56.7% vs 31.9%). Baseline levels of fasting blood glucose and HbA1c levels were similar in both groups.

Sarilumab treatment led to greater reductions in HbA1c level than placebo in both groups, with a larger effect observed in patients with diabetes. At 24 weeks, changes in HbA1c level in patients with RA and diabetes were -0.43% in patients treated with 200 mg sarilumab, and +0.17% in those who had received placebo (P <.001). Safety outcomes were similar in study participants with and without diabetes. The investigators noted that reductions in fasting glucose and HbA1c associated with sarilumab plus DMARD treatment were observed “independent of changes in body weight, high-sensitivity C-reactive protein, American College of Rheumatology response criteria ACR50, or Disease Activity Score 28-joint count C-reactive protein remission status” at 24-week follow-up, and that, “the difference in HbA1c reduction between sarilumab 200 mg [every 2 weeks] and [placebo] was clinically meaningful.”

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Reference

Genovese MC, Fleischmann R, Hagino O, et al. The effect of sarilumab in combination with DMARDs on fasting glucose and glycosylated hemoglobin in patients with rheumatoid arthritis with and without diabetes. Presented at: ACR/ARHP 2017 Annual Meeting; November 3-8, 2017; San Diego, CA. Poster 1822.

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