Mantravadi Santhi, George Michael, Brensinger Colleen, Du Min, Baker Joshua F, Ogdie Alexis
Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 132 South 10th Street, 1170 Main Building, Philadelphia, PA 19107-5244 USA.
Department of Medicine, Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, White Building Rm 5023, 3400 Spruce St, Philadelphia, PA 19104 USA.
BMC Rheumatol. 2020 Sep 2;4:39. doi: 10.1186/s41927-020-00138-3. eCollection 2020.
To determine whether initiation of a tumor necrosis factor inhibitor (TNFi) or methotrexate improves hemoglobin A1c in patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), or ankylosing spondylitis (AS) who also have diabetes mellitus (DM).
A retrospective cohort study was conducted in Optum's de-identified Clinformatics® Data Mart Database, an administrative claims database, using data from 2000 to 2014. Patients with PsA, RA, or AS, with DM (defined by ICD-9-CM codes) and/or HbA1c ≥7%, who newly initiated either a TNFi, MTX, or metformin (positive control) were identified. The change in HbA1c after drug initiation was calculated. Statistical differences in the change in HbA1c between drugs were assessed using the Wilcoxon rank sum test and linear regression models adjusting for potential confounders.
Among 10,389 drug initiations in 9541 patients with PsA, RA, or AS, and available HbA1c values, HbA1c was ≥7 at baseline in 254 (35%) TNFi initiations, 361(37%) MTX initiations, and 2144 (50%) metformin initiations. Median HbA1c change was - 0.35 (IQR -1.10, 0.30) after TNFi initiation, - 0.40 (IQR -1.20, 0.30) after MTX initiation, and - 0.80 (IQR -1.60, - 0.10) after metformin initiation. In adjusted analyses, TNFi initiators had less of a decrease in HbA1c compared to MTX initiators (β 0.22, 95% CI: 0.004, 0.43), = 0.046. Metformin initiators had a significantly greater decrease in HbA1c than MTX, β - 0.38 (95% CI: - 0.52, - 0.23), < 0.001. Glucocorticoid use was not accounted for in the models.
HbA1c decreased with TNFi initiation or MTX initiation. Reductions in HbA1c after initiation of a TNFi or MTX are about half ( 0.4 units) the decrease observed after initiation of metformin.
确定启动肿瘤坏死因子抑制剂（TNFi）或甲氨蝶呤是否能改善同时患有糖尿病（DM）的银屑病关节炎（PsA）、类风湿关节炎（RA）或强直性脊柱炎（AS）患者的糖化血红蛋白（HbA1c）水平。
在Optum的去识别化临床信息学数据集市数据库（一个行政索赔数据库）中进行了一项回顾性队列研究，使用2000年至2014年的数据。识别出患有PsA、RA或AS且患有DM（由ICD - 9 - CM编码定义）和/或HbA1c≥7%，新启动TNFi、甲氨蝶呤（MTX）或二甲双胍（阳性对照）的患者。计算药物启动后HbA1c的变化。使用Wilcoxon秩和检验和调整潜在混杂因素的线性回归模型评估药物之间HbA1c变化的统计学差异。
在9541例患有PsA、RA或AS且有可用HbA1c值的患者中进行的10389次药物启动中，254例（35%）启动TNFi、361例（37%）启动MTX和2144例（50%）启动二甲双胍的患者在基线时HbA1c≥7%。启动TNFi后HbA1c的中位数变化为 - 0.35（四分位间距 - 1.10，0.30），启动MTX后为 - 0.40（四分位间距 - 1.20，0.30），启动二甲双胍后为 - 0.80（四分位间距 - 1.60， - 0.10）。在调整分析中，与启动MTX的患者相比，启动TNFi的患者HbA1c降低幅度较小（β 0.22，95%置信区间：0.004，0.43），P = 0.046。启动二甲双胍的患者HbA1c降低幅度明显大于MTX，β - 0.38（95%置信区间： - 0.52， - 0.23），P < 0.001。模型中未考虑糖皮质激素的使用情况。
启动TNFi或MTX后HbA1c降低。启动TNFi或MTX后HbA1c的降低幅度约为启动二甲双胍后观察到的降低幅度的一半（约0.4个单位）。
