Lu Chieh-Hua, Chung Chi-Hsiang, Lee Chien-Hsing, Su Sheng-Chiang, Liu Jhih-Syuan, Lin Fu-Huang, Tsao Chang-Huei, Hsieh Po-Shiuan, Hung Yi-Jen, Hsieh Chang-Hsun, Chien Wu-Chien
Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine.
Department of Medical Research, Tri-Service General Hospital.
Medicine (Baltimore). 2019 Oct;98(41):e17371. doi: 10.1097/MD.0000000000017371.
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease associated with increased prevalence of type 2 diabetes mellitus (T2DM). Here, we investigated the effect of the combination of cyclooxygenase (COX)-2 inhibitors and metformin on the rate of admission in patients with RA and T2DM and compared it with that of only COX-2 inhibitors.In total, 1268 subjects with RA and T2DM under COX-2 inhibitor and metformin therapy were selected from the National Health Insurance Research Database of Taiwan, along with 2536 patients as 1:2 sex-, age-, and index year-matched controls without metformin therapy. Cox proportional hazard analysis was used to compare the rate of admission during the 10 years of follow-up.At the end of the follow-up, 72 enrolled subjects (1.89%) had admission, including 9 from the combination group (0.71%) and 63 from the COX-2 inhibitor group (2.48%). The combination group was associated with a lower rate of admission at the end of follow-up (P < .001). Cox proportional hazard regression analysis revealed the lower rate of admission for subjects under combination therapy (adjusted hazard ratio of 0.275; 95% confidence interval = 0.136-0.557, P < .001).Patients with RA and T2DM receiving the combination of COX-2 inhibitors and metformin were associated with lower admission rate than those on COX-2 inhibitors alone, and this effect may be attributed to the decrease in the levels of proinflammatory factors.
类风湿性关节炎（RA）是一种慢性、全身性炎症性自身免疫疾病，与2型糖尿病（T2DM）患病率增加相关。在此，我们研究了环氧化酶（COX）-2抑制剂与二甲双胍联合使用对RA合并T2DM患者入院率的影响，并将其与仅使用COX-2抑制剂的情况进行比较。总共从台湾国民健康保险研究数据库中选取了1268例接受COX-2抑制剂和二甲双胍治疗的RA合并T2DM患者，以及2536例作为1:2性别、年龄和索引年份匹配的未接受二甲双胍治疗的对照患者。采用Cox比例风险分析比较随访10年期间的入院率。随访结束时，72例入组患者（1.89%）入院，其中联合治疗组9例（0.71%），COX-2抑制剂组63例（2.48%）。联合治疗组在随访结束时入院率较低（P<0.001）。Cox比例风险回归分析显示联合治疗患者的入院率较低（调整后风险比为0.275；95%置信区间=0.136-0.557，P<0.001）。接受COX-2抑制剂和二甲双胍联合治疗的RA合并T2DM患者的入院率低于仅接受COX-2抑制剂治疗的患者，这种效果可能归因于促炎因子水平的降低。
