WebMD Medical News
Laura J. Martin, MD
June 21, 2011 -- Specific drugs used to treat inflammatory diseases like rheumatoid arthritis (RA) and psoriasis may also help protect patients with these conditions from developing type 2 diabetes, a study shows.
Use of TNF-inhibitor biologic agents such as Enbrel, Humira, and Remicade, and hydroxychloroquine (Plaquenil, Quineprox) was associated with a lower diabetes risk among patients with the inflammatory conditions than use of other disease-modifying antirheumatic drugs (DMARDs) in the study from Harvard Medical School and Brigham and Women's Hospital.
It is increasingly recognized that patients with rheumatoid arthritis and other conditions driven by inflammation may have an elevated risk for heart disease, insulin resistance, and diabetes.
The early findings suggest certain DMARDs lower insulin resistance and help prevent diabetes in patients with these conditions, study researcher Daniel H. Solomon, MD, MPH, tells WebMD.
They also support a potential role for drugs that reduce systemic inflammation in the prevention and treatment of type 2 diabetes.
The study appears in the June 22/29 issue of the Journal of the American Medical Association.
"We are not at the point where we can make clinical leaps and say that these are the drugs to choose for high-risk patients," Solomon says. "But if future studies support the conclusion that these drugs do decrease insulin resistance and diabetes risk, one could imagine a day when we make treatment decisions based on these comorbidities."
Solomon and colleagues analyzed the health records of close to 14,000 patients with rheumatoid arthritis or psoriasis enrolled in two large private health insurance programs -- one in Canada and one in the U.S.
The patients were followed from the time they started one of four categories of commonly prescribed DMARDs: biologic TNF inhibitors, methotrexate, hydroxychloroquine, and other non-biologic agents.
During the follow-up period, 267 new cases of diabetes were diagnosed among the patients.
After taking into account known diabetes risk factors, patients treated with hydroxychloroquine were 46% less likely to develop diabetes and those treated with a TNF inhibitor had a 38% lower risk than patients taking other non-biologic agents.
Methotrexate use was associated with a non-significant reduction in diabetes risk.
Solomon and colleagues are currently conducting a study, sponsored by the National Institutes of Health, that's designed to examine whether hydroxychloroquine improves glucose and insulin profiles in rheumatoid arthritis patients.
He says if this study and others prove positive, routine assessment of insulin resistance may become common in the management of patients with inflammatory diseases.
"We currently have about a dozen drugs that we give patients with rheumatoid arthritis, but we don't really have a clear way of determining which drug is best for which patient," he says. "Understanding how these drugs affect comorbidities like diabetes could help us make more informed treatment choices."
Rheumatologist Tim Bongartz, MD, agrees, but he says we are not there yet.
Bongartz is an assistant professor of medicine at the Mayo Clinic in Rochester, Minn.
"Basic research now tells us that inflammation plays an important role in the development of type 2 diabetes, as well as type 1 diabetes," he tells WebMD. "If randomized trials are promising, diabetes risk may prove to be an important consideration when choosing a treatment strategy for patients with systemic inflammatory disease."
SOURCES:Solomon, D.H. The Journal of the American Medical Association, June 22/29; vol 305: pp 2525-2531.Daniel H. Solomon, MD, MPH, chief of clinical research in rheumatology, Brigham and Women's Hospital; associate professor of medicine, Harvard Medical School, Boston.Tim Bongartz, MD, division of rheumatology, assistant professor of medicine, Mayo Clinic College of Medicine, Rochester, Minn.News release, Brigham and Women's Hospital.News release, JAMA Media.
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