Department of Pharmacy, New Taipei City Hospital, #3, Sec. 1, New Taipei Blvd., Sanchong Dist, New Taipei City, 24141, Taiwan.
School of Pharmacy, College of Pharmacy, Taipei Medical University, #250, Wuxing St, Taipei, 11031, Taiwan.
BMC Infect Dis. 2019 Nov 6;19(1):936. doi: 10.1186/s12879-019-4577-z.
The protective effect of metformin against active tuberculosis (TB) among TB close contacts is unknown.
TB close contacts with diabetes mellitus (DM) and normal renal function were selected from the National Health Insurance Research Database of Taiwan. Metformin users were patients who received ≥90 cumulative defined daily doses within 1 year before the index date. For each metformin user, a propensity-score matched metformin nonuser and an age- and sex-matched healthy TB close contact were selected. The outcome was incident TB, identified using previously validated diagnostic criteria. Independent predictors were investigated using stratified Cox regression analysis. Interaction analysis was also performed.
A total of 5846 TB close contacts who were metformin users, metformin non-users, and healthy contacts were analysed. The incidence of active TB was 755 (600-938), 1117 (927-1335), and 526 (393-689) cases per 100,000 person-years in each group, respectively. Multivariate analysis revealed that healthy contacts had the lowest risk of developing active TB (adjusted hazard ratio [aHR]: 0.42 [0.30-0.60]) and metformin use partially reversed the risk associated with DM (aHR: 0.73 [0.54-0.98]). Subpopulation analysis revealed a significant interaction between insulin use and metformin use.
Metformin use is associated with a lower risk of developing active TB among TB close contacts with DM, especially for insulin users. It may be an alternative choice for primary prevention against active TB if no contraindications exist. However, prospective studies are needed to confirm the findings.
二甲双胍对结核病（TB）密切接触者中活动性结核病（TB）的保护作用尚不清楚。
从台湾全民健康保险研究数据库中选择患有糖尿病（DM）且肾功能正常的 TB 密切接触者。二甲双胍使用者是指在索引日期前 1 年内接受≥90 累计规定日剂量的患者。对于每个二甲双胍使用者，选择一个倾向评分匹配的二甲双胍非使用者和一个年龄及性别匹配的健康 TB 密切接触者。结果是使用先前验证的诊断标准确定的新发 TB。使用分层 Cox 回归分析调查独立预测因素。还进行了交互作用分析。
共分析了 5846 名 TB 密切接触者，他们分别为二甲双胍使用者、二甲双胍非使用者和健康接触者。每组的活动性 TB 发生率分别为 600-938、927-1335 和 393-689 例/100000 人年。多变量分析显示，健康接触者发生活动性 TB 的风险最低（调整后的危险比[aHR]：0.42 [0.30-0.60]），二甲双胍的使用部分逆转了与 DM 相关的风险（aHR：0.73 [0.54-0.98]）。亚组分析显示，胰岛素使用和二甲双胍使用之间存在显著的交互作用。
在患有 DM 的 TB 密切接触者中，二甲双胍的使用与发生活动性 TB 的风险降低相关，尤其是对于胰岛素使用者。如果不存在禁忌症，它可能是预防活动性 TB 的一种替代选择。然而，需要前瞻性研究来证实这些发现。
