Association Between Disease-Modifying Antirheumatic Drugs and Diabetes Risk in Patients With Rheumatoid Arthritis and Psoriasis
Association Between Disease-Modifying Antirheumatic Drugs and Diabetes Risk in Patients With Rheumatoid Arthritis and Psoriasis
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DOI：
10.1001/jama.2011.878
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发表时间：
2011-06-22
影响因子：
120.7
通讯作者：
Schneeweiss, Sebastian
中科院分区：
文献类型：
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作者：
Solomon, Daniel H.;Massarotti, Elena;Schneeweiss, Sebastian
背景类风湿性关节炎(RA)和银屑病与胰岛素抵抗和糖尿病(DM)有关。先前的研究表明，全身性免疫抑制药物可以改善胰岛素抵抗，降低糖尿病的风险。目的比较新记录的类风湿性关节炎或银屑病患者在使用多种抗风湿病药物(DMARD)的基础上发生糖尿病的风险。设计、设置和参与者一项对121 280名至少2次就诊的类风湿性关节炎或银屑病患者的回顾性队列研究。这些分析是在两个大型医疗保险计划的背景下进行的，一个在加拿大，一个在美国，使用的是行政数据。平均随访时间为5.8个月，从符合研究资格的第一个DMARD处方开始。用药方案分为4组：(1)肿瘤坏死因子(TNF)抑制剂联合或不联合其他DMARD；(2)不含肿瘤坏死因子抑制剂或羟基氯喹的氨甲喋呤；(3)不含肿瘤坏死因子抑制剂或甲氨蝶呤的羟基氯喹；或(4)不含肿瘤坏死因子抑制剂、甲氨蝶呤或羟基氯喹的其他非生物DMARDS(参考暴露)。每1000人年新增糖尿病病例和发病率分别为：其他非生物DMARDS(3993次治疗中55例；比率，50.2；95%可信区间，47.3-53.2)；肿瘤坏死因子抑制剂(4623次治疗中80例；比率19.7；95%可信区间，19.1-20.3)；甲氨蝶呤(8195次治疗中82例；比率23.8；95%可信区间，23.0-24.6)；和羟基氯喹(5682次治疗中50例；比率，22.2；95%可信区间，21.3-23.1)。与其他非生物DMARD相比，肿瘤坏死因子抑制剂、氨甲喋呤和羟基氯喹对糖尿病的多因素调整风险比分别为0.62(95%CI，0.42~0.91)、0.77(95%CI，0.53~1.13)和0.54(95%CI，0.36~0.80)。结论在RA或银屑病患者中，使用肿瘤坏死因子抑制剂或羟基氯喹的患者发生DM的调整风险低于其他非生物DMARD。贾玛2011；305(24)：2525-2531
Context Rheumatoid arthritis (RA) and psoriasis have been linked with insulin resistance and diabetes mellitus (DM). Prior investigations suggest that systemic immunosuppressive drugs may improve insulin resistance and reduce the risk of DM.Objective To compare the risk of newly recorded DM among participants diagnosed with RA or psoriasis based on use of a variety of disease-modifying antirheumatic drugs (DMARDs).Design, Setting, and Participants A retrospective cohort study among 121 280 patients with a diagnosis of either RA or psoriasis on at least 2 visits. The analyses were conducted in the context of 2 large health insurance programs, 1 in Canada and 1 in the United States, using administrative data. The mean follow-up was 5.8 months and began with the first prescription for a DMARD after study eligibility was met. Drug regimens were categorized into 4 mutually exclusive groups: (1) tumor necrosis factor (TNF) inhibitors with or without other DMARDs; (2) methotrexate without TNF inhibitors or hydroxychloroquine; (3) hydroxychloroquine without TNF inhibitors or methotrexate; or (4) other nonbiologic DMARDs without TNF inhibitors, methotrexate, or hydroxychloroquine (reference exposure).Main Outcome Measure Newly recorded DM as evidenced by a new diagnosis of DM with use of a DM-specific medication.Results The study cohort consisted of 13 905 participants with 22 493 treatment episodes starting 1 of the categories of DMARD regimens between January 1996 and June 2008. New diabetes cases and respective incidence rates per 1000 person-years were: other nonbiologic DMARDs (55 cases among 3993 treatment episodes; rate, 50.2; 95% confidence interval [CI], 47.3-53.2); TNF inhibitors (80 cases among 4623 treatment episodes; rate, 19.7; 95% CI, 19.1-20.3); methotrexate (82 cases among 8195 treatment episodes; rate, 23.8; 95% CI, 23.0-24.6); and hydroxychloroquine (50 cases among 5682 treatment episodes; rate, 22.2; 95% CI, 21.3-23.1). The multivariate adjusted hazard ratios for DM were 0.62 (95% CI, 0.42-0.91) for TNF inhibitors, 0.77 (95% CI, 0.53-1.13) for methotrexate, and 0.54 (95% CI, 0.36-0.80) for hydroxychloroquine compared with other nonbiologic DMARDS.Conclusion Among patients with RA or psoriasis, the adjusted risk of DM was lower for individuals starting a TNF inhibitor or hydroxychloroquine compared with initiation of other nonbiologic DMARDs. JAMA. 2011;305(24):2525-2531