羟化氯喹可降低RA患者的糖尿病风险

柏林(EGMN)——瑞典卡罗林斯卡大学的Holmqvist博士在欧洲风湿病大会报告，对类风湿性关节炎(RA)患者给予羟化氯喹治疗，可能使患者发生2型糖尿病的风险降低40%以上。

既往一些研究提示，对于RA患者，羟化氯喹有降低糖尿病风险的潜在益处，但这些研究的规模都比较小(J. Clin. Rheumatol. 2011;17:115-20; JAMA 2007;298:187-93)。基于这些研究结果，一些研究者将羟化氯喹称为“化装的糖尿病治疗药物”(BMJ Case Rep. 2009;2009. pii: bcr08.2008.0654)。

在这项纵向前瞻性观察性研究中，Holmqvist博士及其同事于2000~2010年期间对美国10,583例被风湿病医生诊断为RA的患者进行随访。基线时，RA患者的平均年龄为60岁，平均疾病病程为13.6年。1/4的患者接受羟化氯喹单药或联合治疗，30%的患者接受甲氨蝶呤加或不加肿瘤坏死因子(TNF)抑制剂治疗，42%的患者接受其他治疗或未接受缓解疾病抗风湿药物(DMARD)治疗。

结果显示，随访期间，6.4%的受试者被诊断为新发2型糖尿病。发病率为1.34例/100人-年。在校正RA持续时间、种族、体重指数、工作状态、收入、年龄、性别、合并症和健康评估问卷评分的多变量分析中，与美国疾病预防控制中心生成的匹配的美国人群数据相比，使用羟化氯喹与发生糖尿病的几率减少41%相关。只要患者未接受强的松治疗，则甲氨蝶呤加或不加TNF抑制剂治疗与糖尿病风险降低20%相关；如甲氨蝶呤方案中包含强的松，则预防效应消失。与之形成对比的是，羟化氯喹加强的松治疗仍具有保护性，与风险降低40%相关。强的松本身与发生糖尿病的风险增加30%相关。最突出的是，戈利木单抗与风险增加12.3倍相关。其他抗RA药物与糖尿病风险之间均无明显关联。

研究者总结认为，RA患者接受羟化氯喹治疗可显著降低发生糖尿病的风险。

这项研究由卡罗林斯卡研究所和美国国立风湿病数据库资助。Holmqvist博士无相关利益冲突披露。

爱思唯尔  版权所有

BY BRUCE JANCIN
Elsevier Global Medical News
Breaking News

BERLIN (EGMN) – Prescribing hydroxychloroquine for the treatment of rheumatoid arthritis may reduce a patient’s risk of developing type 2 diabetes by more than 40%.

That’s the provocative implication of a longitudinal prospective observational study of 10,583 American patients with rheumatologist-diagnosed rheumatoid arthritis (RA) followed from 2000 through 2010. It’s a clinically important observation in light of the impact of diabetes on cardiovascular risk, Dr. Marie Holmqvist said at the annual European Congress of Rheumatology.

Findings from other, smaller studies also have shown the potential benefit of hydroxychloroquine in lowering the risk of diabetes in RA patients, but none was as large as this one (J. Clin. Rheumatol. 2011;17:115-20; JAMA 2007;298:187-93). The association has led some investigators to dub hydroxychloroquine “a diabetes drug in disguise” (BMJ Case Rep. 2009;2009. pii: bcr08.2008.0654).

At baseline, the patients with RA had an average age of 60 years and a mean 13.6-year disease duration. One-quarter of them were on hydroxychloroquine as mono- or combination therapy, 30% were on methotrexate with or without a tumor necrosis factor (TNF) inhibitor, and 42% were on other or no disease-modifying antirheumatic drugs (DMARDs).

During follow-up, 6.4% of subjects were diagnosed with new-onset type 2 diabetes. The incidence was 1.34 cases per 100 person-years. In a multivariate analysis adjusted for RA duration, ethnicity, body mass index, employment status, income, age, gender, comorbidity, and Health Assessment Questionnaire score, hydroxychloroquine use was independently associated with a 41% reduction in the likelihood of developing diabetes compared with U.S. Centers for Disease Control and Prevention–generated figures for the matched U.S. population.

Methotrexate with or without a TNF inhibitor was associated with a 20% decrease in the risk of diabetes as long as a patient wasn’t also on prednisone. If the methotrexate regimen included prednisone, the protective effect was lost. In contrast, hydroxychloroquine with prednisone remained protective, with an associated 40% risk reduction.

Prednisone by itself was associated with a 30% increased risk of developing diabetes. Most strikingly, golimumab was associated with a 12.3-fold increased risk. None of the other medications prescribed for RA showed a significant relationship with diabetes risk, reported Dr. Holmqvist of Karolinska University, Stockholm.

Her study was funded by the Karolinska Institute and the U.S. National Data Bank for Rheumatic Diseases. Dr. Holmqvist reported having no financial conflicts.