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

Abstract

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.