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Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study.

Abstract

OBJECTIVE

SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLE patients.

METHODS

This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001-10, 8628 newly diagnosed SLE patients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication.

RESULTS

Two hundred and twenty-one newly diagnosed diabetes mellitus patients were identified among SLE patients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g.

CONCLUSION

In SLE patients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use.

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    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

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    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    ,

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.

    Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Department of Medical Research, Department of Psychiatry, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Division of Immunology and Rheumatology, College of Medicine, Institute of Biomedical Science, National Chung-Hsing University and School of Medicine, Chung-Shan Medical University, Taichung, Taiwan Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Faculty of Medicine, School of Medicine, Ins

    Source

    Rheumatology (Oxford, England) 54:7 2015 Jul pg 1244-9

    MeSH

    Adolescent
    Adult
    Antirheumatic Agents
    Cohort Studies
    Diabetes Mellitus
    Dose-Response Relationship, Drug
    Drug Therapy, Combination
    Female
    Follow-Up Studies
    Glucocorticoids
    Glucose
    Humans
    Hydroxychloroquine
    Incidence
    Lupus Erythematosus, Systemic
    Male
    Middle Aged
    Retrospective Studies
    Risk Factors
    Taiwan
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    25587177

    Citation

    Chen, Yi-Ming, et al. "Hydroxychloroquine Reduces Risk of Incident Diabetes Mellitus in Lupus Patients in a Dose-dependent Manner: a Population-based Cohort Study." Rheumatology (Oxford, England), vol. 54, no. 7, 2015, pp. 1244-9.
    Chen YM, Lin CH, Lan TH, et al. Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study. Rheumatology (Oxford). 2015;54(7):1244-9.
    Chen, Y. M., Lin, C. H., Lan, T. H., Chen, H. H., Chang, S. N., Chen, Y. H., ... Chen, D. Y. (2015). Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study. Rheumatology (Oxford, England), 54(7), pp. 1244-9. doi:10.1093/rheumatology/keu451.
    Chen YM, et al. Hydroxychloroquine Reduces Risk of Incident Diabetes Mellitus in Lupus Patients in a Dose-dependent Manner: a Population-based Cohort Study. Rheumatology (Oxford). 2015;54(7):1244-9. PubMed PMID: 25587177.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hydroxychloroquine reduces risk of incident diabetes mellitus in lupus patients in a dose-dependent manner: a population-based cohort study. AU - Chen,Yi-Ming, AU - Lin,Ching-Heng, AU - Lan,Tsuo-Hung, AU - Chen,Hsin-Hua, AU - Chang,Shih-Ni, AU - Chen,Yi-Hsing, AU - Wang,Jun-Sing, AU - Hung,Wei-Ting, AU - Lan,Joung-Liang, AU - Chen,Der-Yuan, Y1 - 2015/01/12/ PY - 2014/04/15/received PY - 2015/1/15/entrez PY - 2015/1/15/pubmed PY - 2015/9/16/medline KW - diabetes KW - glucocorticoid KW - hydroxychloroquine KW - systemic lupus erythematosus SP - 1244 EP - 9 JF - Rheumatology (Oxford, England) JO - Rheumatology (Oxford) VL - 54 IS - 7 N2 - OBJECTIVE: SLE is associated with increased risk of diabetes mellitus. Treatment for SLE requires high-dose glucocorticoids that may worsen glucose homoeostasis. HCQ can reduce diabetes risk in RA. This study aimed to investigate the association of HCQ use and diabetes mellitus risk in SLE patients. METHODS: This nationwide, population-based cohort study was conducted using the Taiwan National Health Insurance Research Database. In the period 2001-10, 8628 newly diagnosed SLE patients were identified after excluding those with a previous diagnosis of RA, psoriasis or diabetes mellitus. Incidence of diabetes mellitus was identified as a new diagnostic code using a diabetes mellitus-specific medication. RESULTS: Two hundred and twenty-one newly diagnosed diabetes mellitus patients were identified among SLE patients (6795 had taken HCQ and 1833 had never taken HCQ), with an average follow-up period of 5.6 years. Compared with patients without HCQ treatment, the hazard ratio (HR) of diabetes mellitus in patients taking HCQ at a cumulative dose ≥129 g was reduced [HR 0.26 (95% CI 0.18, 0.37), P < 0.001]. Daily glucocorticoid ≥10 mg prednisolone-equivalent dose was associated with increased risk of developing diabetes mellitus [HR 2.47 (95% CI 1.44, 4.23), P = 0.001], which was minimized by concomitant HCQ use at a cumulative dose ≥129 g. CONCLUSION: In SLE patients, the use of HCQ is associated with reduced risk of incident diabetes mellitus in a dose-dependent manner. High-dose glucocorticoids increase the risk of diabetes, which can be decreased by concomitant HCQ use. SN - 1462-0332 UR - https://www.unboundmedicine.com/medline/citation/25587177/full_citation L2 - https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/keu451 DB - PRIME DP - Unbound Medicine ER -