GLP-1 受体激动剂治疗患者的骨关节炎进展和全关节置换术的五年发生率。

The Five-Year Incidence of Progression to Osteoarthritis and Total Joint Arthroplasty in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists.

机构信息

Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio; The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio.

出版信息

J Arthroplasty. 2024 Oct;39(10):2433-2439.e1. doi: 10.1016/j.arth.2024.06.008. Epub 2024 Jun 8.

DOI:10.1016/j.arth.2024.06.008

PMID:38857711

Abstract

BACKGROUND

Research has suggested that glucagon-like peptide-1 receptor agonists (GLP-1-RAs) may have therapeutic effects on osteoarthritis of the hip and knee, in addition to managing diabetes and obesity. However, there is a lack of understanding regarding the association between GLP-1-RA use and the diagnosis of osteoarthritis (OA) of the hip and knee.

METHODS

A collaborative network analytics platform was queried for obese diabetic (n = 1,094,198), obese nondiabetic (n = 916,235), and nonobese diabetic (n = 157,305) patients who had an index visit between 2015 and 2017. Patients who had pre-existing hip and/or knee OA were excluded. A 1:1 propensity score matching was used to balance GLP-1-RA use in stratified cohorts for age, sex, race, body mass index, and hemoglobin A1c. The primary outcomes were rates of progression to hip OA, knee OA, major joint injections, total hip arthroplasty, and total knee arthroplasty. Cox proportional hazards models determined hazard ratios (HRs) between cohorts prescribed and not prescribed GLP-1-RAs.

RESULTS

All patients had a five-year follow-up. Rates of progression to hip and knee OA were higher among the GLP-1-RA users in both obese diabetic (hip HR: 1.63, 95% confidence interval [CI]: 1.46 to 1.82; knee HR: 1.52, CI: 1.41 to 1.64) and nonobese diabetic (hip HR: 1.78, CI: 1.50 to 2.10; knee HR: 1.58, CI: 1.39 to 1.80) cohorts. These diabetic cohorts received higher rates of major joint injections, though there was no difference in rates of total hip arthroplasty or total knee arthroplasty. No differences in five-year outcomes were seen when comparing obese, nondiabetic patients who were prescribed GLP-1-RAs with obese, nondiabetic patients not exposed to GLP-1-RAs.

CONCLUSIONS

This five-year analysis found a greater risk of progression to hip and knee OA among obese and non-obese diabetic GLP-1-RA users. Further studies should explore GLP-1-RA effects upon glucose management, weight loss, and lower extremity arthritis development.

LEVEL OF EVIDENCE

III, retrospective cohort study.

摘要

背景

研究表明，胰高血糖素样肽-1 受体激动剂（GLP-1-RAs）除了可用于治疗糖尿病和肥胖症外，可能对髋关节和膝关节骨关节炎也具有治疗作用。然而，人们对 GLP-1-RA 使用与髋关节和膝关节骨关节炎（OA）诊断之间的关联了解甚少。

方法

使用协作网络分析平台查询了 2015 年至 2017 年期间就诊的肥胖型糖尿病（n=1,094,198）、肥胖非糖尿病（n=916,235）和非肥胖型糖尿病（n=157,305）患者的索引就诊信息。排除了有髋关节和/或膝关节 OA 既往病史的患者。采用 1:1 倾向评分匹配方法，按年龄、性别、种族、体重指数和糖化血红蛋白对分层队列中的 GLP-1-RA 使用情况进行匹配。主要结局是髋关节 OA、膝关节 OA、主要关节注射、全髋关节置换术和全膝关节置换术的进展发生率。Cox 比例风险模型确定了处方和未处方 GLP-1-RAs 两组之间的风险比（HRs）。

结果

所有患者均进行了五年随访。在肥胖型糖尿病（髋关节 HR：1.63，95%置信区间 [CI]：1.46 至 1.82；膝关节 HR：1.52，CI：1.41 至 1.64）和非肥胖型糖尿病（髋关节 HR：1.78，CI：1.50 至 2.10；膝关节 HR：1.58，CI：1.39 至 1.80）患者中，GLP-1-RA 使用者进展为髋关节和膝关节 OA 的发生率更高。尽管全髋关节置换术或全膝关节置换术的发生率没有差异，但糖尿病患者的主要关节注射率更高。在比较接受 GLP-1-RA 治疗的肥胖非糖尿病患者与未接受 GLP-1-RA 治疗的肥胖非糖尿病患者时，肥胖非糖尿病患者的五年结局没有差异。