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Comparative Study
. 2019 Oct;98(41):e17371.
doi: 10.1097/MD.0000000000017371.

Combination of COX-2 inhibitor and metformin attenuates rate of admission in patients with rheumatoid arthritis and diabetes in Taiwan

Chieh-Hua Lu  1   2 , Chi-Hsiang Chung  3   4 , Chien-Hsing Lee  1 , Sheng-Chiang Su  1 , Jhih-Syuan Liu  1 , Fu-Huang Lin  3 , Chang-Huei Tsao  2   5 , Po-Shiuan Hsieh  2   6   7 , Yi-Jen Hung  1 , Chang-Hsun Hsieh  1 , Wu-Chien Chien  2   3
Affiliations
Comparative Study

Combination of COX-2 inhibitor and metformin attenuates rate of admission in patients with rheumatoid arthritis and diabetes in Taiwan

Chieh-Hua Lu et al. Medicine (Baltimore). 2019 Oct.

Abstract

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease associated with increased prevalence of type 2 diabetes mellitus (T2DM). Here, we investigated the effect of the combination of cyclooxygenase (COX)-2 inhibitors and metformin on the rate of admission in patients with RA and T2DM and compared it with that of only COX-2 inhibitors.In total, 1268 subjects with RA and T2DM under COX-2 inhibitor and metformin therapy were selected from the National Health Insurance Research Database of Taiwan, along with 2536 patients as 1:2 sex-, age-, and index year-matched controls without metformin therapy. Cox proportional hazard analysis was used to compare the rate of admission during the 10 years of follow-up.At the end of the follow-up, 72 enrolled subjects (1.89%) had admission, including 9 from the combination group (0.71%) and 63 from the COX-2 inhibitor group (2.48%). The combination group was associated with a lower rate of admission at the end of follow-up (P < .001). Cox proportional hazard regression analysis revealed the lower rate of admission for subjects under combination therapy (adjusted hazard ratio of 0.275; 95% confidence interval = 0.136-0.557, P < .001).Patients with RA and T2DM receiving the combination of COX-2 inhibitors and metformin were associated with lower admission rate than those on COX-2 inhibitors alone, and this effect may be attributed to the decrease in the levels of proinflammatory factors.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
The flowchart of study sample selection from the National Health Insurance Research Database in Taiwan. COX-2 = inhibitor/Metformin: ≧90 days, DM = diabetes mellitus: ICD-9-CM 250, RA = rheumatoid arthritis: ICD-9-CM 714.
Figure 2
Figure 2
Kaplan–Meier analysis for the cumulative risk of RA among patients with DM and RA, and patients aged 18 years and over on COX-2 inhibitors stratified by metformin with the log-rank test. DM = diabetes mellitus, RA = rheumatoid arthritis
See this image and copyright information in PMC

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