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Common Rheumatoid Arthritis Treatment Shows Potential for Diabetes Prevention
11-Jul-2007
WebWire
Far fewer rheumatoid arthritis patients treated with the drug
hydroxychloroquine (HCQ) went on to develop diabetes compared to those
who never took the drug, according to a 20-plus-year University of
Pittsburgh School of Medicine-led study reported today in the Journal
of the American Medical Association. In addition, those using HCQ who
did develop diabetes were less likely to take medications to manage
their disease after diagnosis.
The multi-center observational study of 4,905 adults with rheumatoid
arthritis (RA) found that relative risk progressively declined by as
much as 77 percent after four years of treatment with HCQ, a common
antimalarial medication that also is used for rheumatoid arthritis and
other autoimmune disorders.
Additional participating centers in the study are Stanford University,
the National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS), one of the National Institutes of Health (NIH) and
the University of Cincinnati. Co-investigators at Stanford have
directed the project database since its inception with support from the
NIH.
“This reduction in risk persisted even after adjusting for other
diabetes risk factors among these patients, such as body-mass index,
degree of disability and use of corticosteroids,” said rheumatologist
Mary Chester M. Wasko, M.D., M.Sc., associate professor of medicine,
University of Pittsburgh School of Medicine. Because people with RA
tend to be less active and take corticosteroids that can cause weight
gain, they are often considered to be at higher risk for developing
diabetes, a disease in which blood sugar levels become abnormally high
because of the body’s inability to use or produce the hormone insulin.
“Another interesting finding was that the rheumatoid arthritis patients
who developed diabetes were less likely to need blood sugar-lowering
medication to manage their disease,” said Dr. Wasko, whose clinical
research has focused on long-term health improvement in patients with
RA. “However, it is most exciting to consider that this drug might be
appropriate for people with pre-diabetes as a preventive therapy – much
in the same way as a daily baby aspirin is suggested for people at high
risk for heart disease.”
Nationally, diabetes is the fifth leading cause of death, according to
the American Diabetes Association. Many people first become aware of
the disease when confronted with one of its life-threatening
complications such as heart disease, blindness, high blood pressure,
stroke, kidney disease or circulatory problems that can lead to
amputation.
Results show that HCQ’s association with reduction in diabetes risk is
comparable or superior to that of a number of other drugs studied in
clinical trials for diabetes prevention and treatment, including
rosiglitazone, hormones, metformin, acarbose and ramipril. And recent
questions have arisen concerning rosiglitazone, marketed as Avandia,
and a reported increased risk of heart attack.
Although HCQ is not without side effects – nausea, headache and
dizziness, for example – the drug has a long history of being generally
safe and well-tolerated. In addition, Dr. Wasko and her colleagues
observed no apparent negative interactions between HCQ and other drugs
commonly used by RA patients, such as methotrexate and prednisone. An
important limitation of the study, however, is that investigators used
self-report information from patients collected in follow-up twice
yearly that did not include confirmation by laboratory tests.
Other studies of the blood sugar-lowering effects of HCQ have shown
minimal use for the drug as a treatment for people with established
diabetes, Dr. Wasko continued, stressing the treatment’s real promise
may be prevention.
“HCQ already has a role in long-term treatment for RA,
potentially moderating lipids and having a weak anti-clotting effect.
But, optimistically speaking, endocrinologists can identify people who
are at high risk for diabetes, due to obesity, family history, lipid
profile or other characteristics. HCQ may also have a role in delaying
onset of diabetes,” Dr. Wasko said. “More research is needed to verify
our findings in people with RA, and also to determine how this medicine
works. But my ultimate hope is that this relatively inexpensive, safe
drug will be studied as a way to reduce diabetes risk for people who do
not have RA.”
In addition to Dr. Wasko, study authors are Helen B.
Hubert, M.P.H., Ph.D., James F. Fries, M.D., and Vijaya Bharathi
Lingala, Ph.D., all of Stanford University Medical Center; Jennifer R.
Elliott, M.D., University of Pittsburgh School of Medicine; Michael E.
Luggen, M.D., University of Cincinnati; and Michael M. Ward, M.D.,
M.P.H., Intramural Research Program, NIAMS. The study was conducted
with support from the Arthritis Foundation of Western Pennsylvania,
NIAMS and the Intramural Research Program, NIAMS.
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