Wenhui Xie1, Xinlei Yang2, LanLan Ji3, Zhuoli Zhang4. 1. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China. Electronic address: xwh828@sina.cn. 2. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China. Electronic address: yxl1490224646@163.com. 3. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China. Electronic address: jilanlan@gmail.com. 4. Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No.8, Xishiku Street, West District, Beijing 100034, China. Electronic address: zhuoli.zhang@126.com.
Abstract
OBJECTIVES: To evaluate the impact of disease-modifying antirheumatic drugs on the risk of developing diabetes in rheumatoid arthritis (RA) patients without diabetes. METHODS: Electronic database searches of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed from inception to October 2019. The studies assessing the association between diabetes and antirheumatic agents in RA patients in cohort or case-control design were included. Data were pooled using fixed-effects or random-effects meta-analysis according to I2 and pooled hazard ratios (HRs), and 95% confidence intervals (CIs) were used as summary statistic. RESULTS: A total of 15 studies involving 552,019 patients with RA (11 for hydroxychloroquine, 7 for methotrexate, 6 for tumor necrosis factor inhibitors [TNFi], and 8 for glucocorticoids) were included. In pooled analysis, a reduced risk of diabetes was reported with hydroxychloroquine (meta-HR 0.61, 95% CI 0.56-0.66), methotrexate (meta-HR 0.81, 95% CI 0.75-0.87), TNFi (meta-HR 0.63, 95% CI 0.55-0.71), while glucocorticoids was associated with an increased risk of developing diabetes in a dose-dependent manner (Any dose: meta-HR 1.46, 95% CI 1.39-1.53; <10 mg/day prednisolone or equivalent: meta-HR 1.30, 95% CI 1.13-1.51; ≥10 mg/day prednisolone or equivalent: meta-HR 2.25, 95% CI 1.88-2.70). CONCLUSIONS: Hydroxychloroquine, methotrexate and TNFi were associated with decreased risk of diabetes, and glucocorticoids with increased risk in RA patients. These important findings may aid clinical decision-making in the management of RA. Large, prospective, well-designed studies are needed in the RA patients with high-risk diabetes.
OBJECTIVES: To evaluate the impact of disease-modifying antirheumatic drugs on the risk of developing diabetes in rheumatoid arthritis (RA) patients without diabetes. METHODS: Electronic database searches of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed from inception to October 2019. The studies assessing the association between diabetes and antirheumatic agents in RApatients in cohort or case-control design were included. Data were pooled using fixed-effects or random-effects meta-analysis according to I2 and pooled hazard ratios (HRs), and 95% confidence intervals (CIs) were used as summary statistic. RESULTS: A total of 15 studies involving 552,019 patients with RA (11 for hydroxychloroquine, 7 for methotrexate, 6 for tumor necrosis factor inhibitors [TNFi], and 8 for glucocorticoids) were included. In pooled analysis, a reduced risk of diabetes was reported with hydroxychloroquine (meta-HR 0.61, 95% CI 0.56-0.66), methotrexate (meta-HR 0.81, 95% CI 0.75-0.87), TNFi (meta-HR 0.63, 95% CI 0.55-0.71), while glucocorticoids was associated with an increased risk of developing diabetes in a dose-dependent manner (Any dose: meta-HR 1.46, 95% CI 1.39-1.53; <10 mg/day prednisolone or equivalent: meta-HR 1.30, 95% CI 1.13-1.51; ≥10 mg/day prednisolone or equivalent: meta-HR 2.25, 95% CI 1.88-2.70). CONCLUSIONS:Hydroxychloroquine, methotrexate and TNFi were associated with decreased risk of diabetes, and glucocorticoids with increased risk in RApatients. These important findings may aid clinical decision-making in the management of RA. Large, prospective, well-designed studies are needed in the RApatients with high-risk diabetes.
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