Association between type 2 diabetes and short-term clinical response to TNF inhibitors in patients with ankylosing spondylitis: a propensity score-matched retrospective cohort study.

Authors

Ziyi Yang, Duofen Liu, Zhibing Sun, Yimin Yan

Published in

Clinical rheumatology. Aug 13, 2026. Epub Aug 13, 2026.

Abstract

Type 2 diabetes mellitus (T2DM) is a common comorbidity in clinical practice, yet its association with tumor necrosis factor inhibitor (TNFi) response in ankylosing spondylitis (AS) has not been characterized. We hypothesized that comorbid T2DM may be associated with reduced short-term clinical response to TNFi in patients with AS.
This single-center retrospective cohort study included patients with AS initiating TNFi between January 2020 and December 2025. T2DM was identified from ICD-coded medical records. Propensity score 1:2 nearest-neighbor matching was performed using five baseline covariates. The primary outcome was short-term clinical response, defined as a BASDAI decrease of ≥ 2 points at 90-180 days. Fisher exact test was the primary analysis; Mantel-Haenszel stratified analysis served as supplementary analysis.
After matching, 10 diabetic and 20 non-diabetic patients were analyzed. The response rate was 20.0% (2/10) in the diabetic group versus 75.0% (15/20) in the non-diabetic group (OR = 0.092; P = 0.007). Mantel-Haenszel analysis yielded a consistent direction (OR = 0.083; 95% CI, 0.011-0.618). Median ΔBASDAI was - 0.62 versus - 2.75 (P = 0.005), and median ΔESR was - 3.50 versus - 21.50 mm/h (P = 0.031).
T2DM was associated with a lower probability of short-term clinical response to TNFi in patients with AS (20.0% vs 75.0% in the matched analysis; 20.0% vs 63.6% in the full cohort). This hypothesis-generating signal was consistent across multiple analytic approaches but may be confounded by unmeasured factors including glycemic control, BMI, diabetes duration and treatment, smoking status, and objective disease activity. Validation in prospective multicenter studies incorporating HbA1c, ASDAS-CRP, and comprehensive metabolic phenotyping is warranted. Key Points • Comorbid type 2 diabetes was associated with a lower short-term clinical response rate to TNFi in patients with ankylosing spondylitis (20.0% vs 75.0%). • The association was consistent across BASDAI improvement, ESR reduction, and CRP normalization, but ΔCRP differences attenuated after excluding extreme baseline values. • The association was consistent across PSM-based and full-cohort adjusted analyses, but may be confounded by unmeasured factors and should be interpreted as hypothesis-generating.

PMID:
42593580
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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