ASSOCIATION BETWEEN USE OF DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS AND DIABETES IN PATIENTS WITH ANKYLOSING SPONDYLITIS, RHEUMATOID ARTHRITIS, OR PSORIASIS/PSORIATIC ARTHRITIS: NATIONWIDE, POPULATION-BASED COHORT STUDY OF 84,989 PATIENTS

Background: Previous studies suggested anti-tumor necrosis factor (TNF) agents and hydroxychloroquine (HCQ) may inhibit the development of insulin resistance. Objectives: Investigate the association between use of disease-modifying antirheumatic drugs (DMARDs) and diabetes mellitus (DM) in patients with ankylosing spondylitis (AS), rheumatoid arthritis (RA), or psoriasis (PSO)/psoriatic arthritis (PSA). Methods: This retrospective cohort study used a nationwide, population-based administrative database to enroll 84,989 cases with AS, RA, or PSO/PSA who initiated treatment with anti-TNFs or nonbiologic DMARDs. Multivariable analysis was used to estimate effect of different therapies on risk of DM. Results: There were 36,329 patients with AS, 33,112 patients with RA, and 15,638 patients with PS or PSA. All enrolled patients initiated treatment with an anti-TNF agent or a nonbiologic DMARD. We categorized patients into 4 mutually exclusive groups based on DMARD use: (i) anti-TNF agent with or without another DMARD (n=6824); (ii) cyclosporine (CSA) without an anti-TNF agent or HCQ (n=1084); (iii) HCQ without an anti-TNF agent or CSA (n=27,033); and (iv) other nonbiologic DMARD without an anti-TNF agent, CSA, or HCQ (n=50,048), hereafter referred to as the reference group.The incidence rates of DM per 1000 person-years were 8.3 for users of anti-TNFs, 13.3 for users of cyclosporine (CSA), 8.4 for users of HCQ, and 8.1 for users of other nonbiologic DMARDs. Compared with users of nonbiologic DMARDs, the multivariate adjusted hazard ratios (aHRs) for DM were significantly lower for users of anti-TNFs with HCQ (aHR: 0.49, 95% CI: 0.36–0.66) and those who used HCQ (aHR: 0.70, 95% CI: 0.63–0.78), but not in those who used anti-TNFs without HCQ (aHR: 1.23, 95% CI: 0.94–1.60) or CSA (aHR: 1.14, 95% CI: 0.77–1.70). Table 1. Univariate (crude HR) and multivariate (adjusted HR) analysis of factors associated with DM DMARD groupCrude HR (95% CI)P-valueAdjusted HR (95% CI)P-value Other non-biologic DMARDsReferenceReference Anti-TNF+HCQ0.73 (0.55, 0.97)0.028*0.49 (0.36, 0.66)<0.001* Anti-TNF alone1.52 (1.20, 1.92)<0.001*1.23 (0.94, 1.60)0.125 CSA1.64 (1.11, 2.41)0.013*1.14 (0.77, 1.70)0.510 HCQ1.03 (0.95, 1.12)0.4450.70 (0.63, 0.78)<0.001* HR: hazard ratio; CI: confidence interval. *P<0.05 indicates a significant association with DM. Adjusted by age, sex, disease group, disease duration, pre-treatment Charlson comorbididy index and corticosteroid dose. Conclusions: The aHR for DM was lowest for RA and PSO/PSA patients who initiated treatment with an anti-TNF agent with concomitant HCQ, followed by HCQ users. References: 1. Antohe JL, Bili A, Sartorius JA, et al. Diabetes mellitus risk in rheumatoid arthritis: reduced incidence with anti-tumor necrosis factor α therapy. Arthritis Care Res (Hoboken). 2012;64:215–21. 2. Wasko MC, Hubert HB, Lingala VB, et al. Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis. JAMA 2007;298:187–93. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2016-eular.1257Citation: Annals of the Rheumatic Diseases, volume 75, supplement 2, year 2016, page 119Session: Epidemiology of RMDs (Oral Presentations )