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P099. Anti-TNF-alpha treatment improves carbohydrate metabolism in patients with inflammatory bowel disease

K. Lorinczy1, P. Miheller1, A. Patócs1, H. Székely1, P. Reismann1, Á. Csontos1, B. Fekete1, O. Terjék1, L. Herszényi1, A. Somogyi1, Z. Tulassay1, 1Semmelweis University, 2nd Department of Internal Medicine, Budapest, Hungary

Background

TNF-alpha has an important role in metabolic profile and insulin resistance. Adipose tissue has been recognized as an immune organ that secretes numerous immunomodulatory factors and seems to be a significant source of inflammatory signals known to cause insulin resistance. However, the regulation of carbohydrate metabolism by TNF-alpha in inflammatory bowel disease (IBD) is poorly understood. Previous studies have shown increase endogenous ghrelin production among patients suffering from IBD. The aim of our study was to assess the changes of serum ghrelin levels and progress of anti-TNFa therapy in IBD.

Methods

17 IBD patients (4 with ulcerative colitis [UC], 13 with Crohn's disease [CD]) were treated with biological therapy (5 mg infliximab per kg at week 0, 2, 6 and then in every 8 weeks; or adalimumab 160/80 as an induction and 40 mg/2 weeks as a maintenance therapy). Mean age of the patients was 34.2±9 years. Oral glucose tolerance test were performed and markers of carbohydrate metabolism (ghrelin), inflammatory and routine parameters were measured at the first visit than 3 and 12 month later. Insulin resistance calculated by homeostatic model assessment (HOMA-IR). Ghrelin levels were mesured by radioimmunoassay using polyclonal rabbit-antibody. Calculations were performed using SPSS statistics 15.0 software.

Results

The insulin resistance significantly decreased to the 3th and 12nd month of the therapy (HOMA-IR at week 0.: 1.40±1.02 vs. week 12.: 0.27±0.24, and month 12.: 0.20±0.38, respectively; p < 0.01). Oral glucose tolerance improved at the end of the study (Figure 1.).

We observed decreasing trend in ghrelin concentrations (at week 0.: 1044.60±427.95 vs. week 12.: 957.77±170.33 vs. month 12.: 944.03±260.50; NS). There was strong correlation between ghrelin levels and hemoglobin-A1c levels (r = 0.74). Ghrelin concentration does not correlated neither to clinical activity indexes (partial Mayo score: r = 0.391; Crohn's disease activity index: r = 0.120457), nor inflammatory parameters (C-reactive protein: r = −0.11).

Figure 1. Oral glucose tolerance.

Conclusion

Anti-TNF-alpha therapy improves insulin resistance in IBD patients. Improving metabolic parameters of patients treated with anti-TNF agents is an additional benefit of this kind of medications in IBD.