Diabetes Rx May Keep Arthritis at Bay

Diabetes medication may decrease risk of rheumatoid arthritis and other autoimmune diseases

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Call it a gut reaction. A popular diabetes medication works by helping gastrointestinal hormones that encourage insulin production. The same medication may also help ward off autoimmune diseases.

DPP-4 (dipeptidyl peptidase IV) is an enzyme that turns off gastrointestinal hormones called incretins. Incretins are helpful for insulin secretion, which helps lower blood sugar. By taking DPP-4 inhibitors, diabetes patients may block this anti-incretin enzyme and better control blood sugar levels.

Scientists recently observed that these diabetes medications may also help prevent rheumatoid arthritis, lupus, inflammatory bowel disease, psoriasis and multiple sclerosis.

"Ask a pharmacist about benefits and side effects of DPP-4 inhibitors."

Seoyoung Kim, MD, assistant professor of medicine in the Division of Pharmacoepidemiology & Pharmacoeconomics and Division of Rheumatology, Immunology and Allergy at Brigham and Women’s Hospital in Boston, led this investigation, analyzing insurance records on 58,275 patients with type 2 diabetes who had DPP-4 inhibitor [DDP4i] treatment.

Scientists matched their medical data to patients who did not have DPP-4 therapy. All patients were 40 or older.

Common DPP-4 inhibitors approved by the Food and Drug Administration for type 2 diabetes therapy are linagliptin (brand name Tradjenta), sitagliptin (brand name Januvia), saxagliptin (brand name Onglyza) and alogliptin (brand name Nesina).

Dr. Kim and his colleagues discovered that patients who were starting to take DPP-4 inhibitors (in combination with other therapy) appeared to be 34 percent less likely to develop rheumatoid arthritis and 27 percent less likely to develop other autoimmune diseases compared to those who received other therapy but not DPP-4 inhibitors.

The authors noted, however, that results were based on overall low incidence of these diseases. Only about one in 1,000 had rheumatoid arthritis or an autoimmune disease.

“Among patients with type 2 diabetes, initiating DPP4i combination therapy may be associated with a decreased risk of rheumatoid arthritis or other autoimmune diseases compared to initiating non-DPP4i combination therapy,” said Dr. Kim in a press release. “Although our results are not definitive, these results may contribute to the understanding of new mechanistic pathways for preventing or delaying the onset of autoimmune diseases. It could also lead to a potential new therapeutic approach. Future research is needed to determine the effect and safety of DPP4i in the non-diabetic population.”

Registered pharmacist Jason Poquette, BPharm, RPh, told dailyRx News, “Patients should realize that these medications [DPP-4 inhibitors], while generally well-tolerated and safe, do carry the risk of some side effects. They may, though rarely, cause an abnormal inflammation of the pancreas. We advise patients to contact their physician immediately if they notice any unusual abdominal pain or vomiting.  Also, if taking a DPP-4 inhibitor with another medication for diabetes, the risk of developing low blood sugar (hypoglycemia) is increased, so they should watch out for those signs as well. More common and less concerning side effects, which may go away, include anxiety, upper respiratory infection, stuffy and/or runny nose, headache and dizziness.”

Poquette added, “The possibility that this category of medication may also give us insights into treatments or prevention of autoimmune disorders is interesting. For diabetic patients with a family history of rheumatoid arthritis, this study may provide some additional motivation to use DPP-4 inhibitors for treatment.”

The research will be presented October 29 during the American College of Rheumatology Annual Meeting at the San Diego Convention Center. Authors disclosed receiving support from Pfizer Inc., Novartis Pharmaceutical Corporation, Boehringer Ingelheim, Lilly and Amgen.

Review Date: 
October 25, 2013
Last Updated:
October 28, 2013