Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis.
<h4>Objective</h4>Inflammation and anti-inflammatory treatments might influence the risk of diabetes. The objective of this study was to assess factors associated with incident diabetes in rheumatoid arthritis (RA).<h4>Methods</h4>The study population consisted of RA patients...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0210459 |
| _version_ | 1819146010686914560 |
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| author | Siri Lillegraven Jeffrey D Greenberg George W Reed Katherine Saunders Jeffrey R Curtis Leslie Harrold Marc C Hochberg Dimitrios A Pappas Joel M Kremer Daniel H Solomon |
| author_facet | Siri Lillegraven Jeffrey D Greenberg George W Reed Katherine Saunders Jeffrey R Curtis Leslie Harrold Marc C Hochberg Dimitrios A Pappas Joel M Kremer Daniel H Solomon |
| author_sort | Siri Lillegraven |
| collection | DOAJ |
| description | <h4>Objective</h4>Inflammation and anti-inflammatory treatments might influence the risk of diabetes. The objective of this study was to assess factors associated with incident diabetes in rheumatoid arthritis (RA).<h4>Methods</h4>The study population consisted of RA patients from a multi-center cohort study, Corrona. To assess risk associated with disease modifying antirheumatic drug (DMARD) exposure, we assessed five mutually exclusive DMARD groups. Additionally, we assessed the risk associated with body mass index (BMI, <25, 25-30, >30 kg/m2) and glucocorticoid usage. Incident cases of diabetes were confirmed through adjudication, and Cox regression models were fit to estimate the risk of incident diabetes.<h4>Results</h4>We identified 21,775 DMARD treatment regimens, the mean (SD) age at the index visit was 58 (13) years, disease duration 10 (10) years, and 30% used oral glucocorticoids at the time. Eighty-four incident cases of diabetes were confirmed within the treatment exposure periods. The hazard ratio (HR, 95% confidence interval) for diabetes was significantly reduced in patients receiving TNF inhibitors, HR 0.35 (0.13, 0.91), compared to patients treated with non-biologic DMARDs other than hydroxychloroquine and methotrexate. Hydroxychloroquine, methotrexate and use of other biologic DMARDs had a numerically reduced risk compared to the same group. Patients prescribed ≥7.5 mg of glucocorticoids had a HR of 2.33 (1.68, 3.22) of incident diabetes compared with patients not prescribed oral glucocorticoids. RA patients with a BMI >30 had a HR of 6.27 (2.97, 13.25) compared to patients with BMI ≤25.<h4>Conclusion</h4>DMARDs, glucocorticoids and obesity influenced the risk of incident diabetes in a large cohort of RA patients. Monitoring for the occurrence of diabetes should be part of routine RA management with a focus on specific subgroups. |
| first_indexed | 2024-12-22T13:07:08Z |
| format | Article |
| id | doaj.art-e35121fcf08d4ca8be74b90dbf535994 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T13:07:08Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-e35121fcf08d4ca8be74b90dbf5359942022-12-21T18:24:50ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01141e021045910.1371/journal.pone.0210459Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis.Siri LillegravenJeffrey D GreenbergGeorge W ReedKatherine SaundersJeffrey R CurtisLeslie HarroldMarc C HochbergDimitrios A PappasJoel M KremerDaniel H Solomon<h4>Objective</h4>Inflammation and anti-inflammatory treatments might influence the risk of diabetes. The objective of this study was to assess factors associated with incident diabetes in rheumatoid arthritis (RA).<h4>Methods</h4>The study population consisted of RA patients from a multi-center cohort study, Corrona. To assess risk associated with disease modifying antirheumatic drug (DMARD) exposure, we assessed five mutually exclusive DMARD groups. Additionally, we assessed the risk associated with body mass index (BMI, <25, 25-30, >30 kg/m2) and glucocorticoid usage. Incident cases of diabetes were confirmed through adjudication, and Cox regression models were fit to estimate the risk of incident diabetes.<h4>Results</h4>We identified 21,775 DMARD treatment regimens, the mean (SD) age at the index visit was 58 (13) years, disease duration 10 (10) years, and 30% used oral glucocorticoids at the time. Eighty-four incident cases of diabetes were confirmed within the treatment exposure periods. The hazard ratio (HR, 95% confidence interval) for diabetes was significantly reduced in patients receiving TNF inhibitors, HR 0.35 (0.13, 0.91), compared to patients treated with non-biologic DMARDs other than hydroxychloroquine and methotrexate. Hydroxychloroquine, methotrexate and use of other biologic DMARDs had a numerically reduced risk compared to the same group. Patients prescribed ≥7.5 mg of glucocorticoids had a HR of 2.33 (1.68, 3.22) of incident diabetes compared with patients not prescribed oral glucocorticoids. RA patients with a BMI >30 had a HR of 6.27 (2.97, 13.25) compared to patients with BMI ≤25.<h4>Conclusion</h4>DMARDs, glucocorticoids and obesity influenced the risk of incident diabetes in a large cohort of RA patients. Monitoring for the occurrence of diabetes should be part of routine RA management with a focus on specific subgroups.https://doi.org/10.1371/journal.pone.0210459 |
| spellingShingle | Siri Lillegraven Jeffrey D Greenberg George W Reed Katherine Saunders Jeffrey R Curtis Leslie Harrold Marc C Hochberg Dimitrios A Pappas Joel M Kremer Daniel H Solomon Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. PLoS ONE |
| title | Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. |
| title_full | Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. |
| title_fullStr | Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. |
| title_full_unstemmed | Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. |
| title_short | Immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis. |
| title_sort | immunosuppressive treatment and the risk of diabetes in rheumatoid arthritis |
| url | https://doi.org/10.1371/journal.pone.0210459 |
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