Hydroxychloroquine and Risk of Diabetes in Patients With Rhe

Hydroxychloroquine and Risk of Diabetes in Patients With Rheumatoid Arthritis



Mary Chester M. Wasko, MD, MSc; Helen B. Hubert, MPH, PhD; Vijaya
Bharathi Lingala, PhD; Jennifer R. Elliott, MD; Michael E. Luggen, MD;
James F. Fries, MD; Michael M. Ward, MD, MPH



JAMA. 2007;298:187-193.



Context Hydroxychloroquine, a commonly used antirheumatic
medication, has hypoglycemic effects and may reduce the risk of
diabetes mellitus.



Objective To determine the association between
hydroxychloroquine use and the incidence of self-reported diabetes in a
cohort of patients with rheumatoid arthritis.



Design, Setting, and Patients A prospective, multicenter
observational study of 4905 adults with rheumatoid arthritis (1808 had
taken hydroxychloroquine and 3097 had never taken hydroxychloroquine)
and no diagnosis or treatment for diabetes in outpatient
university-based and community-based rheumatology practices with 21.5
years of follow-up (January 1983 through July 2004).



Main Outcome Measures Diabetes by self-report of diagnosis or hypoglycemic medication use.



Results During the observation period, incident diabetes was
reported by 54 patients who had taken hydroxychloroquine and by 171
patients who had never taken hydroxychloroquine, with incidence rates
of 5.2 per 1000 patient-years of observation compared with 8.9 per 1000
patient-years of observation, respectively (P < .001). In
time-varying multivariable analysis with adjustments for possible
confounding factors, the hazard ratio for incident diabetes among
patients who had taken hydroxychloroquine was 0.62 (95% confidence
interval, 0.42-0.92) compared with those who had not taken
hydroxychloroquine. In Poisson regression, the risk of incident
diabetes was significantly reduced with increased duration of
hydroxychloroquine use (P < .001 for trend); among those taking
hydroxychloroquine for more than 4 years (n = 384), the adjusted
relative risk of developing diabetes was 0.23 (95% confidence interval,
0.11-0.50; P < .001), compared with those who had not taken
hydroxychloroquine.



Conclusion Among patients with rheumatoid arthritis, use of hydroxychloroquine is associated with a reduced risk of diabetes.





Author Affiliations: Division of Rheumatology and Clinical
Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs
Wasko and Elliott); Stanford University Medical Center, Palo Alto,
California (Drs Hubert, Lingala, and Fries); Division of Immunology,
University of Cincinnati, Cincinnati, Ohio (Dr Luggen); and Intramural
Research Program, National Institute of Arthritis and Musculoskeletal
and Skin Diseases, National Institutes of Health, Bethesda, Maryland
(Dr Ward).