title: Anti-TNF-α therapy improves insulin sensitivity in non-diabetic patients with psoriasis: a 6-month prospective study.
abstract: OBJECTIVE
  Psoriasis is a chronic inflammatory disease associated with increased risk of cardiovascular death. Several studies have shown a beneficial effect of anti-TNF-α therapy on the mechanisms associated with accelerated atherogenesis in patients with inflammatory arthritis, including an improvement of insulin sensitivity. In this study, we aimed to determine for the first time whether the anti-TNF-α monoclonal antibody adalimumab may improve insulin sensitivity in non-diabetic patients with psoriasis.
  
  
  METHODS
  Prospective study on a series of consecutive non-diabetic patients with moderate to severe psoriasis seen at the Dermatology Division of Hospital Universitario Marques de Valdecilla (Northern Spain) who completed 6 months of therapy with adalimumab (80 mg at week 0 followed by 40 mg every other week, starting 1 week after the initial dose). Patients with chronic kidney disease, hypertension or body mass index ≥ 35 kg/m(2) were excluded. Metabolic and clinical evaluation including assessment of insulin sensitivity using the Quantitative Insulin Sensitivity Check Index (QUICKI) was performed at the onset of the treatment (time 0) and at month 6.
  
  
  RESULTS
  Twenty-nine patients (52% women; 38.6 ± 10.7 years) with moderate to severe psoriasis [body surface area (BSA) 37.9 ± 16.3%], Psoriasis Area and Severity Index [(PASI) 18.9 ± 7.8] were assessed. Statistically significant improvement (P=0.008) of insulin sensitivity was observed after 6 months of adalimumab therapy (QUICKI at time 0: 0.35 ± 0.04 vs. 0.37 ± 0.04 at month 6). Significant improvement of erythrocyte sedimentation rate, ultrasensitive C-reactive protein, BSA, PASI, Nail Psoriasis Severity Index, physician global assessment and psoriatic arthritis screening and evaluation questionnaire was also observed at month 6 (P < 0.05 for each variable).
  
  
  CONCLUSIONS
  Our results support a beneficial effect of the anti-TNF-α blockade on the mechanisms associated with accelerated atherogenesis in patients with psoriasis.
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Pina
authors.affiliation: Dermatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Armesto
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Lopez-Mejias
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Genre
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Ubilla
authors.affiliation: Dermatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gonzalez-Lopez
authors.affiliation: Pathology Division, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain.
authors.forename: M C
authors.initials: MC
authors.lastname: Gonzalez-Vela
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Corrales
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Endocrinology Research Unit, Medical Laboratory Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Garcia-Unzueta
authors.affiliation: Department of Internal Medicine, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Hernandez
authors.affiliation: Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Llorca
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gonzalez-Gay
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D003920:Diabetes Mellitus; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D007279:Injections, Subcutaneous; D007333:Insulin Resistance; D008297:Male; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab