Clinical Newswire, October 10, 2008 - The use of hydroxychloroquine- an antimalarial medication currently used to treat some autoimmune diseases, in rheumatoid arthritis (RA) patients, may prevent the development of diabetes, according to research presented at the 2008 Annual Meeting of the American College of Rheumatology.
Despite multiple risk factors for diabetes, including treatment with steroids and sedentary lifestyle, people with RA are not affected by diabetes more often than the general population. It has been speculated that the use of the antimalarial medication hydroxychloroquine may be the reason for the unexpectedly low rates of diabetes incidence in RA patients.
A self-report study published in the Journal of the American Medical Association (JAMA) in 2007 showed a 77% reduction in the incidence of diabetes in RA patients who were taking hydroxychloroquine for over 4 years. To verify these findings, researchers from the Geisinger Medical Center and Geisinger Center for Health Research, Danville, PA, used an electronic health record database with physician-coded diagnoses and laboratory measures.
The database was used to identify 1,824 patients with RA without diabetes and collected data on demographics, body mass index (BMI), laboratory results and medication use. The majority of patients were women (74%) and 97% were Caucasian, with mean age of 62.4 years and BMI 29.3 kg/m2.
Patients were divided into groups based on previous hydroxychloroquine use and rates of new incidence of diabetes, defined as diagnosis of diabetes or random serum glucose exceeding 200mg/dl or hemoglobin A1c ≧7 or hypoglycemic drug use, were compared in hydroxychloroquine users and non-users.
There were 525 patients who had previously taken hydroxychloroquine and 1299 who had never taken the drug. Mean follow-up was 36.2 and 36.8 months, respectively. During observation, the rate of incident DM was about 50% lower in patients who were hydroxychloroquine users than in non-users (17.2 vs. 33.8 new cases of DM per 1,000 people per year, p=0.01). Further analysis adjusted for gender, age, BMI, positive RF and anti-CCP, use of steroids, methotrexate and anti-tumor necrosis factor inhibitors, showed that having ever used hydroxychloroquine was associated with a 53% reduction in the risk of developing diabetes (95% CI 0.26-0.82, p=0.008). The duration of hydroxychloroquine use did not influence the outcome, and no interaction between medications were identified.
These results confirm and strengthen the protective association between hydroxychloroquine use and the risk of developing DM. The study authors conclude that hydroxychloroquine may be useful in the prevention and treatment of DM in the general population, considering the relative safety and low cost this generic drug.
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