PReS-FINAL-2188: Insulin sensitivity is improved in sjia children with insulin resistance after tocilizumab treatment: results from the tender study

Methods Patients (pts) from TENDER were included if baseline and wk 6 fasting insulin were measured. Glucocorticoid tapering was not permitted until wk 6. Insulin sensitivity was quantified using the homeostatic model of insulin resistance (HOMA-IR). Pts were classified as having IR if their HOMA-IR was ≥2.2 U. Change in HOMA-IR after 6 wks was assessed using paired t-test. Baseline associations with HOMA-IR and factors predicting change of HOMA-IR from baseline were assessed using regression analyses. Factors changing in association with HOMA-IR change were assessed. Results 92 pts with sJIA were analysed. 62 were randomised to TCZ and 30 to placebo, 12 of whom required escape therapy with TCZ by wk 6. At baseline, 40 pts (43%) had IR. Baseline HOMA-IR was associated with higher standardised body mass index and higher IL-6 levels (b-coefficient [95% CI]: 0.20 [0.05, 0.35] and 0.019 [0.001, 0.038], respectively) but not with JADAS, CRP, active joint count or presence of fever. Of the 74 pts who received TCZ, 34 (46%) had IR at baseline, including 4 pts who escaped from the placebo arm, compared with 6/18 (33%) who received only placebo. IR pts treated with TCZ but not placebo had significant reductions in HOMA-IR at wk 6 (Table). Across all IR pts, improvement in JADAS and active joint count was not associated with improvement in HOMA-IR (b-coefficient [95% CI]: 0.04 [-0.07, 0.14] and 0.08 [-0.06, 0.22], respectively).