Abstract
IntroductionTreatment with various biological agents in disease states such as rheumatoid arthritis has been associated with multiple side effects. Whereas many of these are frequently reported in the literature, hypoglycemia, a possible side effect of tumor necrosis factor-alpha inhibitors, may be underpublicized.Case presentationWe report nine cases of non-diabetic Caucasian women who were between 29 and 68 years of age and who developed low glucose readings after treatment with tumor necrosis factor-alpha inhibitors. We provide a more detailed discussion of existing evidence of the role of tumor necrosis factor-alpha in the pathogenesis of inflammation and its impact on glycemic equilibrium.ConclusionsPhysicians using tumor necrosis factor-alpha inhibitors in the treatment of various rheumatic and other autoimmune diseases should be aware of the potential for the development of glycemic disturbance in these patients. A further role of tumor necrosis factor-alpha inhibitors in the glycemic equilibrium warrants larger controlled trials in patients with and those without a history of diabetes.
Highlights
Treatment with various biological agents in disease states such as rheumatoid arthritis has been associated with multiple side effects
Physicians using tumor necrosis factor-alpha inhibitors in the treatment of various rheumatic and other autoimmune diseases should be aware of the potential for the development of glycemic disturbance in these patients
Treatment with a biologic agent is useful for controlling inflammatory disease states, such as rheumatoid arthritis (RA), when disease-modifying anti-rheumatic drugs (DMARDs) are not enough to fully control their activities [1]
Summary
We presented nine cases of non-diabetic patients who developed episodes of low blood glucose readings after treatment with TNF-a inhibitors. Physicians using TNF-a inhibitors in the treatment of various rheumatic and autoimmune diseases should be aware of the potential for the development of glycemic disturbance in these patients, a side effect that may be underpublicized. Further randomized controlled studies on the relationship between TNF-a inhibitors and glycemic control are warranted, along with more studies examining the possible therapeutic role of TNF-a inhibitors in controlling other autoimmune diseases, such as DM. Authors’ contributions JBC analyzed and interpreted patient data regarding hypoglycemic events and was a major contributor in writing the manuscript. BS performed chart review and assisted with the analysis and interpretation of patient data regarding hypoglycemic events. Competing interests The authors declare that they have no competing interests
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