University of British Columbia, Vancouver, British Columbia, Canada, Arthritis Research Canada, Richmond, British Columbia, Canada, and Collaboration for Outcomes Research and Evaluation, Vancouver, British Columbia, Canada.
Arthritis Research Canada, Richmond, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2021 May;73(5):702-706. doi: 10.1002/acr.24147.
To evaluate the association between adherence to antimalarials and type 2 diabetes mellitus (DM) in patients with systemic lupus erythematosus (SLE).
Using administrative health databases in British Columbia, Canada, we conducted a retrospective, longitudinal cohort study of patients with incident SLE and incident antimalarial use. We established antimalarial drug courses by defining a new course when a 90-day gap is exceeded between refills and we calculated proportion of days covered (PDC) for each course. We categorized medication taking as: 1) adherent (PDC ≥0.90), 2) nonadherent (0 < PDC < 0.90), and 3) discontinuer (no drug). Type 2 DM outcomes were based on outpatient or inpatient visits, or antidiabetic medication use. We used multivariable Cox proportional hazards models with time-dependent variables.
Over a median of 4.62 years of follow-up in our incident cohort of 1,498 patients with SLE (90.8% women), we recorded 140 incident cases of type 2 DM. Multivariable hazard ratios were 0.61 (95% confidence interval [95% CI] 0.40-0.93) for adherent and 0.78 (95% CI 0.50-1.22) for nonadherent, respectively, as compared to discontinuers.
Our findings of a protective effect of adherence to antimalarials in preventing type 2 DM provides further support for the importance of adherence to antimalarials to obtain the benefits of therapy.
评估系统性红斑狼疮（SLE）患者服用抗疟药物的依从性与 2 型糖尿病（DM）之间的关联。
我们使用加拿大不列颠哥伦比亚省的行政健康数据库，对新诊断的 SLE 患者和新使用抗疟药物的患者进行了回顾性、纵向队列研究。我们通过定义在两次配药之间超过 90 天的间隔来确定新的抗疟药物疗程，并计算每个疗程的覆盖率（PDC）。我们将药物服用情况分为：1）依从性（PDC≥0.90）、2）非依从性（0<PDC<0.90）和 3）停药（无药物）。2 型 DM 结局基于门诊或住院就诊或使用抗糖尿病药物的情况。我们使用了具有时变变量的多变量 Cox 比例风险模型。
在我们新诊断的 SLE 患者队列（90.8%为女性）中，患者中位随访时间为 4.62 年，记录了 140 例 2 型 DM 新发病例。与停药者相比，依从性和非依从性的多变量风险比分别为 0.61（95%置信区间[95%CI]为 0.40-0.93）和 0.78（95%CI 为 0.50-1.22）。
我们发现，服用抗疟药物的依从性可预防 2 型 DM，这进一步支持了为获得治疗益处而坚持服用抗疟药物的重要性。
