Risk of diabetes mellitus associated with disease-modifying antirheumatic drugs and statins in rheumatoid arthritis.
OBJECTIVE
To investigate the rate of incident diabetes mellitus (DM) in patients with rheumatoid arthritis (RA) and the impact of disease-modifying antirheumatic drug (DMARD) and statin treatments.


METHODS
We studied patients with RA and ≥1 year participation in the National Data Bank for Rheumatic Diseases without baseline DM from 2000 through 2014. DM was determined by self-report or initiating DM medication. DMARDs were categorised into four mutually exclusive groups: (1) methotrexate monotherapy (reference); (2) any abatacept with or without synthetic DMARDs (3) any other DMARDs with methotrexate; (4) all other DMARDs without methotrexate; along with separate statin, glucocorticoid and hydroxychloroquine (yes/no) variables. Time-varying Cox proportional hazard models were used to adjust for age, sex, socioeconomic status, comorbidities, body mass index and RA severity measures.


RESULTS
During a median (IQR) 4.6 (2.5-8.8) years of follow-up in 13 669 patients with RA, 1139 incident DM cases were observed. The standardised incidence ratio (95% CI) of DM in patients with RA (1.37, (1.29 to 1.45)) was increased compared with US adult population. Adjusted HR (95% CI) for DM were 0.67 (0.57 to 0.80) for hydroxychloroquine, 0.52 (0.31 to 0.89) for abatacept (compared with methotrexate monotherapy), 1.31 (1.15 to 1.49) for glucocorticoids and 1.56 (1.36 to 1.78) for statins. Other synthetic/biological DMARDs were not associated with any risk change. Concomitant use of glucocorticoids did not alter DM risk reduction with hydroxychloroquine (HR 0.69 (0.51 to 0.93)).


CONCLUSIONS
In RA, incidence of DM is increased. Hydroxychloroquine and abatacept were associated with decreased risk of DM, and glucocorticoids and statins with increased risk.
University of Nebraska Medical Center, Omaha, Nebraska, USA.|Faculty of Medicine, Marmara University, Istanbul, Turkey.
Gulsen
G
Ozen
National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA.
Sofia
S
Pedro
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Marie E
ME
Holmqvist
Regional Health, Rapid City, South Dakota, USA.
Michael
M
Avery
National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA.
Frederick
F
Wolfe
University of Nebraska Medical Center, Omaha, Nebraska, USA.|National Data Bank for Rheumatic Diseases, Wichita, Kansas, USA.
Kaleb
K
Michaud
D000069594:Abatacept / Q000627:therapeutic use; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D016016:Proportional Hazards Models; D065840:Protective Factors; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D006886:Hydroxychloroquine; D000069594:Abatacept; D008727:Methotrexate
DMARDs (biologic); DMARDs (synthetic); Outcomes research; Rheumatoid Arthritis