Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Impact of Treatment with Methotrexate and TNF Alpha Inhibitors on Insulin Resistance in Patients with Psoriasis
Psoriasis Hastalarında Metotreksat ve TNF Alfa İnhibitörleri Tedavisinin İnsülin Direncine Etkisi
Damla DEMİRa, Ezgi AKTAŞ KARABAYb, İlknur KIVANÇ ALTUNAYa, Feyza YENER ÖZTÜRKc
aHealth Sciences University Şişli Hamidiye Etfal Training and Research Hospital, Department of Dermatology and Venereology, İstanbul, TURKEY
bBahçeşehir University Faculty of Medicine, Department of Dermatology and Venereology, İstanbul, TURKEY
cHealth Sciences University Sisli Hamidiye Etfal Training and Research Hospital, Department of Endocrinology, İstanbul, TURKEY
Turkiye Klinikleri J Dermatol. 2020;30(2):35-43
doi: 10.5336/dermato.2020-74503
Article Language: EN
Full Text
ABSTRACT
 Objective: A strong link between psoriasis and obesity, type 2 diabetes, insulin resistance dyslipidaemia and metabolic syndrome has been documented. The aim of this study was to investigate the effects of methotrexate (MTX), a conventional antipsoriatic agent, and tumour necrosis factor (TNF)-alpha inhibitors (TNFi) on insulin resistance in patients with psoriasis. Material and Methods: Thirty-one patients with psoriasis treated with MTX and TNFi were prospectively evaluated. Seventeen patients received MTX, while 14 received the TNFi treatment. At the baseline and at week 12 values of serum C-reactive protein (CRP), the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and lipid parameters were evaluated. Results: The decrease in CRP levels after the treatment was significantly higher in the TNFi group than in the MTX group (-1.76 vs. -0.1, p = 0.005; respectively). The levels of serum glucose showed increases in both therapy groups, which was statistically significant in only TNFi group (p = 0.012). Although it was not statistically significant, increases in the HOMA-IR values were noted in MTX and TNFi therapy groups (0.26 ± 1.77 vs. 0.59±1.81, p = 0.558, p = 249; respectively). Conclusion: In the present study, a significant increase in the levels of fasting serum glucose was observed in TNFi group, and an increase in HOMA-IR values was noted in both therapy groups, which is not consistent with the literature. Despite the short follow-up period and small sample size, we believe that the effects of the TNFi and MTX demand caution for the follow-up of psoriasis, which is already an insulin-resistant condition.

Keywords: İnsulin resistance; methotrexate; psoriasis; treatment; tumour necrosis factor-alpha inhibitors
ÖZET
 Amaç: Psoriasis ve obezite, tip 2 Diyabet, insulin direnci, dislipidemi ve metabolik sendrom arasında güçlü bir ilişki olduğu bilinmektedir. Bu çalışmanın amacı geleneksel bir antipsoriatik ajan olan metotreksat (MTX) ile tümör nekroz faktörü alfa inhibitörlerinin (TNFi) psoriasis hastalarında insulin direnci üzerine etkilerini araştırmaktır. Gereç ve Yöntemler: MTX ve TNFi tedavisi alan 31 psoriasis hastası prospektif olarak incelendi. 17 hasta MTX tedavisi, 14 hasta ise TNFi tedavisi aldı. Tedavi başlangıcında ve tedavinin 12. haftasında serum C-reactif protein (CRP), HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) ve lipid parametreleri değerlendirildi. Bulgular: Tedavi sonrası CRP değerlerindeki düşüş TNFi grubunda MTX grubuna göre anlamlı olarak daha fazlaydı (-1,76 vs. -0,1, p=0,005; sırasıyla). Serum glukoz değerleri her iki tedavi grubunda da artış gösterse de bu artış sadece TNFi grubunda istatistiksel olarak anlamlıydı (p=0,012). İstatistiksel olarak anlamlı olmasa da MTX ve TNFi tedavi gruplarında HOMAIR değerlerinde artış izlendi (0,26±1,77 vs. 0,59±1,81, p=0,558, p= 249; sırasıyla). Sonuç: Bu çalışmada serum açlık glukoz düzeylerinde TNFi grubunda istatistiksel olarak anlamlı bir artış ve iki tedavi grubunda da HOMA-IR düzeylerinde artış izlenmiştir. Bu bulgular varolan literatür bilgisi ile uyumlu değildir. Kısa takip süresi ve küçük hasta grubuna rağmen insulin direncinin eşlik ettiği bir durum olan psoriasiste MTX ve TNFi tedavilerinde dikkatli olunmalıdır.

Anahtar Kelimeler: İnsulin direnci; metotreksat; psoriasis; tedavi; tümör nekroz faktörü-alfa inhibitörleri
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