Rheumatoid arthritis (RA) and diabetes mellitus (DM) are associated with inflammation. We tried to investigate the influence of tumor necrosis factor inhibitors (TNFi) and tocilizumab (TCZ) on the glucose metabolism of RA patients. RA patients in whom treatment with TNFi or TCZ was initiated from 2008 to 2015 were studied based on their medical records. We analyzed patients whose glycosylated hemoglobin (HbA1c) levels were measured both before and 3 months after the initiation of these biologic agents. The association between HbA1c reduction and the treatment was evaluated. From 971 cases treated with these biologic agents, 221 cases whose medical records of HbA1c were available, were included (TNFi, n = 154; TCZ, n = 67). Both the TNFi and TCZ groups had significantly lower HbA1c values at 1 month and 3 months after the initiation of treatment (TNFi, p<0.001; TCZ, p<0.001). Although the pretreatment HbA1c values did not differ (TNFi, 6.2%; TCZ, 6.2%; p = 0.532), the 3-month treatment HbA1c values were lower (TNFi, 6.1%; TCZ, 5.8%; p = 0.010) and the changes in HbA1c (ΔHbA1c) were greater (TNFi, 0.1%; TCZ, 0.4%; p<0.001) in the TCZ group. The reduction of HbA1c—defined by the achievement of a ΔHbA1c of ≥0.5%—was associated with baseline diagnosis of diabetes mellitus, baseline diabetes treatment, hospitalization, medical change during the observation period, and TCZ. In the multivariate logistic regression analysis, TCZ was associated with the reduction of HbA1c in comparison to TNFi (adjusted OR = 5.59, 95% CI = 2.56–12.2; p<0.001). The HbA1c levels in RA patients were significantly lower after the initiation of TNFi or TCZ. Our study suggests that TCZ decreases the HbA1c levels in RA patients to a greater extent than TNFi.

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We evaluated the clinical characteristics of autoimmune manifestations (AIMs) associated with myelodysplastic syndrome (MDS) to elucidate whether AIMs impacted MDS outcomes in Japan. This retrospective study including 61 patients who received a new diagnosis of MDS between January 2008 and December 2015 was conducted by the review of electronic medical records for the presence of AIMs within a 1-year period prior to or following the diagnosis of MDS. AIMs were identified in 12 of the 61 (20.0%) patients with MDS. The neutrophil counts and C-reactive protein levels in peripheral blood were significantly elevated in patients with AIMs, and the survival was shorter in those with AIMs compared to those without AIMs. Multivariate analysis demonstrated that the presence of AIMs and higher-risk disease according to the International Prognositic Scoring System (IPSS) were independent risk factors for increased mortality (hazard ratio, 4.76 and 4.79, respectively). This retrospective study revealed that the prognosis was poor in patients with MDS-associated AIMs. The treatment of MDS using the current algorithms is based on prognostic scoring systems such as IPSS. Treatment strategies for patients with MDS-associated AIMs should be reconsidered, even in those with low-risk MDS according to the IPSS.

Objectives To evaluate the impact of medication on antibody response to SARS-CoV-2 mRNA vaccines in Japanese patients with rheumatic diseases. Methods This prospective multicenter cohort study evaluated the humoral response in 12 different medication groups. Antibody levels before the first vaccination and 3-6 weeks after the second vaccination were measured using the Elecsys Anti-SARS-CoV-2 S assay. Statistical analysis included comparing antibody titers among the different medication groups using the Kruskal–Wallis test followed by the Bonferroni–Dunn test and multiple linear regression analysis. Results Two hundred and ninety-five patients were analyzed. The seroconversion rate was 92.2% and the median antibody titer was 255 U/ml (interquartile range, 34.1-685) after the second mRNA vaccination. Antibody levels were significantly lower in the groups treated with TNF inhibitor (TNFi) with methotrexate (MTX), abatacept, mycophenolate mofetil (MMF), MMF or mizoribine (MMF/MZR) combined with calcineurin inhibitor (CNI), and rituximab or cyclophosphamide (RTX/CPA) compared with those treated with sulfasalazine and/or bucillamine or CNI (p&lt;0.01). The correlation between antibody titer and treatment was significant after adjusting for age, gender, and glucocorticoid dose (p&lt;0.01). Conclusions Additional early vaccination is required in patients treated with TNFi and MTX, abatacept, MMF, MMF or MZR combined with CNI and CPA/RTX.

Background: To evaluate the impact of medication on antibody response to SARS-CoV-2 mRNA vaccines in Japanese patients with rheumatic diseases.Methods: This prospective multicenter cohort study evaluated the humoral response in 12 different medication groups. Antibody levels before the first vaccination and 3-6 weeks after the second vaccination were measured using the Elecsys Anti-SARS-CoV-2 S assay. Statistical analysis included comparing antibody titers among the different medication groups using the Kruskal–Wallis test followed by the Bonferroni–Dunn test for multiple comparisons and multiple linear regression analysis.Results: Three hundred and seventy-two patients receiving treatment for rheumatic diseases were enrolled, and 295 patients were analyzed. The seroconversion rate was 92.2% and the median antibody titer was 255 U/ml (interquartile range; IQR, 34.1-685) after the second mRNA vaccination. Antibody levels were significantly lower in the groups treated with TNF inhibitor (TNFi) with methotrexate (MTX) (median, 104 U/ml; IQR, 33.2-260), abatacept (median, 48.2 U/ml; IQR, 17.9-182), mycophenolate mofetil (MMF) (median, 3.24 U/ml; IQR, 0-34), MMF or mizoribine (MMF/MZR) combined with calcineurin inhibitor (CNI) (median, 5.5 U/ml; IQR, 0-21), and rituximab or cyclophosphamide (RTX/CPA) (median, 19.5 U/ml; IQR, 0-142) compared with those treated with sulfasalazine and/or bucillamine (median, 831 U/ml; IQR, 451-1451.5) or CNI (median, 833 U/ml; IQR, 164-1882) (p<0.01). Conclusions: Additional early vaccination is required in patients treated with TNFi and MTX, ABT, MMF, MMF or MZR combined with CNI and CPA/RTX. However, patients treated with CNI and sulfasalazine and/or bucillamine may be safer among patients with rheumatic diseases.