Hydroxychloroquine lowers the risk for Diabetes Mellitus in patients with Systemic Lupus Erythematosus

Background

Previous literature suggests a lower prevalence of diabetes mellitus (DM) in patients with systemic lupus erythematosus (SLE).

Study question

We aimed to investigate the impact of hydroxychloroquine (HCQ) on the risk of DM in patients with SLE.

Study design

We queried The TriNetX database for all patients aged >18 years diagnosed with SLE from January 1, 2000, until January 1, 2021. We identified patients with SLE using disease–specific International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code (M32). At the time of enrollment, we excluded all patients who were diagnosed with diabetes mellitus (ICD-10 code: E08-E13) either prior to or at the initial visit.

Measures and outcomes

Patients were classified into two groups according to treatment with HCQ. The primary objective was to compare the impact of HCQ over a consecutive 10-year period on the risk of DM in an SLE population.

Results

Following propensity matching an equal cohort, 19025 SLE patients on HCQ and 19025 SLE controls, were included with a mean period of follow-up of 10 years. Patients who were adherent to HCQ had lower rates of DM (event rate: 13.3% vs 18.5%) with relative risk (RR) 72.0% (68.7% to 75.4%). In Kaplan-Meier survival analysis the cumulative probability of survival was significantly higher in the HCQ subjects compared to control (78.1% vs 68.3%; log-rank, p<0.001).

Conclusion

We provide further evidence for the antidiabetic effect of hydroxychloroquine in a lupus cohort. We suggest a unifying hypothesis linking the pharmacologic effect of hydroxychloroquine with its favorable effects on glucose metabolism.