No Change in HbA1c Levels During Treatment with Biologics or Methotrexate in Patients with Psoriasis.

Biological treatment has been associated with changes in blood glucose levels in different populations of patients with immunological diseases, although studies report conflicting results. This study aimed to investigate changes in blood glucose during treatment with biologics and methotrexate as a control, through changes in hemoglobin A1c (HbA1c) levels. In this study, the HbA1c levels at baseline and after 1 year of treatment were compared using Wilcoxon's signed-rank test. The following treatments were considered: TNF-α inhibitors (TNFi) (adalimumab and infliximab), IL-17 inhibitors (IL-17i) (brodalumab, ixekizumab and secukinumab), IL-12/23 inhibitor (IL-12/23i) (ustekinumab), IL-23 inhibitors (IL-23i) (guselkumab and risankizumab) and methotrexate. In total, 386 patients were included: adalimumab (n=166), infliximab (n=7), brodalumab (n=19), ixekizumab (n=35), secukinumab (n=44), ustekinumab (n=42), guselkumab (n=11), risankizumab (n=7), and methotrexate (n=55). For all groups of biologics and methotrexate, no statistically or clinically significant changes in HbA1c levels were observed. Treatment with secukinumab lead to a 1 mmol/mol increase in median HbA1c from 33 (30;36) mmol/mol to 34 (31;37) mmol/mol, but this was not considered clinically significant. In a sensitivity analysis including only patients in the upper quartile of baseline HbA1c (36-47 mmol/mol) treated with TNFi, IL-17i, or methotrexate, no significant change in HbA1c was observed after 1 year of treatment. Treatment of patients with psoriasis with biologics or methotrexate for 1 year does not appear to affect blood glucose levels as measured by HbA1c. This could indicate that the treatments lack antidiabetic properties.