DMARDs Reduce Diabetes Risk in RA and Psoriasis

July 28, 2011

In patients who have rheumatoid arthritis (RA) or psoriasis, there is a reduced risk of diabetes mellitus (DM) with the use of a tumor necrosis factor α (TNF-α)inhibitor or hydroxychloroquine (HCQ), but not with methotrexate (MTX), compared with other nonbiologic disease-modifying antirheumatic drugs (DMARDs). Evidence suggests a possible role for DMARDs and immunosuppression in DM prevention

In patients who have rheumatoid arthritis (RA) or psoriasis, there is a reduced risk of diabetes mellitus (DM) with the use of a tumor necrosis factor α (TNF-α) inhibitor or hydroxychloroquine (HCQ), but not with methotrexate (MTX), compared with other nonbiologic disease-modifying antirheumatic drugs (DMARDs). Evidence suggests a possible role for DMARDs and immunosuppression in DM prevention.

Solomon and associates conducted a cohort analysis of 121,280 patients with a diagnosis of RA or psoriasis on at least 2 visits. Drug regimens were categorized as 1 of 4 groups: (1) TNF-α inhibitors with or without other DMARDs; (2) MTX without TNF-α inhibitors or HCQ; (3) HCQ without TNF-α inhibitors or MTX; or (4) other nonbiologic DMARDs without TNF-α inhibitors, MTX, or HCQ.

The investigators found 267 newly diagnosed cases of DM (nonbiologic DMARD users, 55; TNF-α inhibitor users, 80; MTX users, 82; and HCQ users, 50). The multivariate adjusted hazard ratios for DM were 0.62, 0.77, and 0.54 for TNF-α inhibitors, MTX, and HCQ, respectively, compared with other nonbiologic DMARDs.

The authors noted that a randomized controlled trial testing the ability of these agents to prevent DM among participants who have a systemic inflammatory disorder should be considered.