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Disease-modifying anti-rheumatic drugs associated with different diabetes risks in patients with rheumatoid arthritis

Yu-Jih Su1,2,3, Hui-Ming Chen4, Tien-Ming Chan5

  • 1Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

RMD Open
|July 17, 2023
PubMed
Abstract

Insights

Patients with rheumatoid arthritis (RA) using certain disease-modifying anti-rheumatic drugs (DMARDs) show a reduced risk of developing diabetes. Biological DMARDs and combination therapies were associated with lower diabetes incidence compared to methotrexate monotherapy.

Area of Science:

  • Rheumatology
  • Endocrinology
  • Clinical Pharmacology

Background:

  • Rheumatoid arthritis (RA) patients face increased risks of diabetes and cardiovascular disease.
  • Existing RA treatments may influence diabetes development, necessitating further investigation.
  • Understanding treatment-specific diabetes risk is crucial for patient management.

Purpose of the Study:

  • To evaluate the association between different disease-modifying anti-rheumatic drug (DMARD) regimens and new-onset diabetes in RA patients.
  • To identify specific DMARDs or combinations that may mitigate diabetes risk.
  • To analyze other potential risk factors for diabetes in this population.

Main Methods:

  • A cohort study utilizing the Chang Gung Research Database.
  • Inclusion criteria: 5530 adults with RA and no prior diabetes diagnosis.
  • Endpoint: New-onset diabetes (HbA1c ≥7%), analyzed across methotrexate monotherapy, biological DMARDs, MTX combination, other conventional DMARDs, and non-DMARD periods.

Main Results:

  • 9.87% of participants developed new-onset diabetes between 2001 and 2018.
  • Significantly lower diabetes risk observed with biological DMARDs (HR 0.51), MTX combination (HR 0.50), and other conventional DMARDs (HR 0.56) compared to MTX monotherapy.
  • Hydroxychloroquine demonstrated a protective effect (HR 0.52); TNF-α inhibitors showed a trend towards protection (HR 0.69).

Conclusions:

  • RA treatment choice significantly impacts diabetes risk.
  • Biological DMARDs, combination therapies, and certain conventional DMARDs like hydroxychloroquine may offer protection against diabetes development in RA patients.
  • Personalized treatment strategies considering diabetes risk are warranted for RA management.
Keywords:
HydroxychloroquineRheumatoid ArthritisTumor Necrosis Factor Inhibitors

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