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Patients Taking Disease-Modifying Antirheumatic Drugs Also Developed Less New Diabetes

Decreased incidence was associated with TNF antagonists and hydroxychloroquine but not with methotrexate.

Chronic inflammatory diseases, including psoriasis and rheumatoid arthritis, have been linked to increased risk for cardiovascular diseases. Psoriasis particularly has been linked to obesity, insulin resistance, and the metabolic syndrome. Evidence from small studies suggests that immunosuppressive agents used to treat inflammatory disease might moderate risk for cardiac disease.

These investigators sought an association between use of disease-modifying antirheumatic drugs (DMARDs) by 13,905 patients with psoriasis or rheumatoid arthritis and risk for diabetes. They compared rates of new diabetes in groups of patients with no prior diabetes who had received one of four immunosuppressive regimens:

• Tumor necrosis factor (TNF) inhibitors, with or without other DMARDs;
• Methotrexate, without TNF antagonists or hydroxychloroquine;
• Hydroxychloroquine, without methotrexate or TNF agents;
• Other DMARDs.

In the mean follow-up period of 5.8 months, incidence rates per 1000 person-years of new diabetes in these groups were:

• 50.2 (confidence interval, 47.3–53.2) with other DMARDs;
• 23.8 (CI, 23.0–24.6) with methotrexate;
• 22.2 (CI, 21.3–23.1) with hydroxychloroquine;
• And 19.7 (CI, 19.1–20.3) with TNF antagonists.

TNF antagonists and hydroxychloroquine, but not methotrexate, significantly reduced relative risk for diabetes incidence compared with other DMARDs.

Comment: Authors of an accompanying editorial discuss other medications with pleiotropic effects (a new term for me) — e.g., improved survival with aspirin after myocardial infarction. They postulate possible mechanisms of action, including hydroxychloroquine-mediated lysosomal stabilization that decreases degradation of insulin receptors and effects of anti-TNF agents on adipose tissue macrophages. Lower risk for diabetes suggests improved survival in recipients of these agents, at least in terms of cardiovascular health. The study was supported by Amgen (maker of etanercept and anakinra), but, the authors state, without editorial control. Bottom line: Accumulating evidence suggests an association between inflammation-suppressing agents and improved survival and health outcomes.

— Jeffrey P. Callen, MD

Published in Journal Watch Dermatology July 15, 2011

Citation(s):

Solomon DH et al. Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis. JAMA 2011 Jun 22/29; 305:2525.

• Original article (Subscription may be required)
• Medline abstract (Free)

Bongartz T and Kudva Y. Can treatment of chronic inflammatory diseases reduce the risk of diabetes mellitus? JAMA 2011 Jun 22/29; 305:2573.

• Original article (Subscription may be required)
• Medline abstract (Free)

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