Abstract
ObjectiveMetformin has been linked to anti-proliferative and anti-inflammatory mechanisms. In this study, we aimed to examine the long-term impact of metformin on mortality and organ damage in patients with autoimmune diseases and type 2 diabetes mellitus (T2DM).MethodsWe conducted a cohort study using the National Health Insurance Research Database in Taiwan between 1997 and 2013. Based on metformin and other anti-diabetic agent prescriptions, we categorized all patients with autoimmune diseases into either the metformin group (metformin administration for at least 28 days) or the non-metformin group. The primary outcomes were all-cause mortality and annual admission rate, while the secondary outcome was target organ damage. We followed patients from the index date to the date on which the event of interest occurred, death, or the end of this study.ResultsOur cohort study included 3,359 subjects for analysis. During a mean follow up of 5.2 ± 3.8 years, the event rate of all-cause mortality was 228 (33.6%) in the metformin group and 125 (36.9%) in the non-metformin group. The risk of both all-cause mortality and annual number of admissions for autoimmune diseases was significantly lower in the metformin group than in the non-metformin group [hazard ratio (HR) 0.77; 95% CI 0.62–0.96 and risk ratio (RR) 0.81; 95% CI 0.73–0.90, respectively].ConclusionMetformin may add benefits beyond T2DM control with regard to reducing all-cause mortality and admission rate, as well as minimizing end-organ injury in lungs and kidneys among patients with autoimmune diseases.
Highlights
Immunosuppressive agents and corticosteroids have long been a cornerstone of treatment for various autoimmune diseases (AD)
We found a total of 120,802 patients with AD between January 1, 1997 and December 31, 2013
3,359 patients (2.78%) were eligible for analysis. After reviewing their medication history, we observed that 3,015 patients (89.75%) were found to be prescribed metformin, while only 344 patients (10.24%) were prescribed other anti-diabetic agents (Figure 1)
Summary
Immunosuppressive agents and corticosteroids have long been a cornerstone of treatment for various autoimmune diseases (AD). A recent clinical trial has demonstrated that the use of metformin in patients with systemic lupus erythematosus (SLE) resulted in decreased disease activity [1]. Considerable evidence has demonstrated that chronic low-grade inflammation caused by activation of the innate immune system is vital in the pathogenesis of T2DM and major complications, as well as that the antidiabetic drug metformin exhibits various anti-proliferative and antiinflammatory mechanisms [3]. Increasing studies have indicated that metformin can reduce cardiovascular mortality [4], cancer mortality [5], all-cause mortality [6], and intensive care unit mortality [7]. Previous studies have rarely investigated the role of metformin in patients with AD and T2DM with regard to mortality [8]
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