Shahrzad Salmasi1, Eric C Sayre2, J Antonio Aviña-Zubieta3, John M Esdaile3, Mary A De Vera1. 1. University of British Columbia, Vancouver, British Columbia, Canada, Arthritis Research Canada, Richmond, British Columbia, Canada, and Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada. 2. Arthritis Research Canada, Richmond, British Columbia, Canada. 3. Arthritis Research Canada, Richmond, British Columbia, Canada, and University of British Columbia, Vancouver, British Columbia.
Abstract
OBJECTIVE: To evaluate the association between adherence to antimalarials and type 2 diabetes mellitus (DM) in patients with systemic lupus erythematosus (SLE). METHODS: Using administrative health databases in British Columbia, Canada, we conducted a retrospective, longitudinal cohort study of patients with incident SLE and incident antimalarial use. We established antimalarial drug courses by defining a new course when a 90-day gap is exceeded between refills and we calculated proportion of days covered (PDC) for each course. We categorized medication taking as: 1) adherent (PDC ≥0.90), 2) nonadherent (0 < PDC < 0.90), and 3) discontinuer (no drug). Type 2 DM outcomes were based on outpatient or inpatient visits, or antidiabetic medication use. We used multivariable Cox proportional hazards models with time-dependent variables. RESULTS: Over a median of 4.62 years of follow-up in our incident cohort of 1,498 patients with SLE (90.8% women), we recorded 140 incident cases of type 2 DM. Multivariable hazard ratios were 0.61 (95% confidence interval [95% CI] 0.40-0.93) for adherent and 0.78 (95% CI 0.50-1.22) for nonadherent, respectively, as compared to discontinuers. CONCLUSION: Our findings of a protective effect of adherence to antimalarials in preventing type 2 DM provides further support for the importance of adherence to antimalarials to obtain the benefits of therapy.
OBJECTIVE: To evaluate the association between adherence to antimalarials and type 2 diabetes mellitus (DM) in patients with systemic lupus erythematosus (SLE). METHODS: Using administrative health databases in British Columbia, Canada, we conducted a retrospective, longitudinal cohort study of patients with incident SLE and incident antimalarial use. We established antimalarial drug courses by defining a new course when a 90-day gap is exceeded between refills and we calculated proportion of days covered (PDC) for each course. We categorized medication taking as: 1) adherent (PDC ≥0.90), 2) nonadherent (0 < PDC < 0.90), and 3) discontinuer (no drug). Type 2 DM outcomes were based on outpatient or inpatient visits, or antidiabetic medication use. We used multivariable Cox proportional hazards models with time-dependent variables. RESULTS: Over a median of 4.62 years of follow-up in our incident cohort of 1,498 patients with SLE (90.8% women), we recorded 140 incident cases of type 2 DM. Multivariable hazard ratios were 0.61 (95% confidence interval [95% CI] 0.40-0.93) for adherent and 0.78 (95% CI 0.50-1.22) for nonadherent, respectively, as compared to discontinuers. CONCLUSION: Our findings of a protective effect of adherence to antimalarials in preventing type 2 DM provides further support for the importance of adherence to antimalarials to obtain the benefits of therapy.
Authors: Shahrzad Salmasi; Ayano Kelly; Susan J Bartlett; Maarten de Wit; Lyn March; Allison Tong; Peter Tugwell; Kathleen Tymms; Suzanne Verstappen; Mary A De Vera Journal: BMC Rheumatol Date: 2021-07-08