Researchers examined the records of 2,093 Geisinger patients who received treatment for rheumatoid arthritis from 2000 to 2008. The study looked at, among other things, use of the medication hydroxychloroquine (HCQ) and the development of new cases of diabetes in these patients.
HCQ was developed to treat malaria but it has also been used to treat rheumatoid arthritis and other autoimmune diseases.
In patients with rheumatoid arthritis, use of HCQ was associated with a 53 percent reduction in the development of new cases of diabetes, the study found.
"Given the relative safety and low cost of this generic drug, HCQ may be useful in preventing diabetes in other high risk groups," said lead study investigator and Geisinger rheumatologist Androniki Bili, MD, MPH.
Researchers don't know how exactly HCQ prevents diabetes onset but it's suspected that HCQ improves glucose tolerance.
Dr. Bili presented the study's findings Monday at the American College of Rheumatology Annual Scientific Meeting in San Francisco.
About 23.6 million Americans have diabetes, while 1.3 million have rheumatoid arthritis.
People with rheumatoid arthritis are at increased risk for diabetes due to more sedentary lifestyle, chronic inflammation and use of steroid medications that can cause weight gain.
"We should revisit HCQ in the treatment of rheumatoid arthritis because, in addition to its disease-modifying properties, it might prevent the development of diabetes in this high risk group," Dr. Bili said.
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At the end of the four-month study, both groups were given milk powder as a "challenge" to see what dose would cause reaction after the treatment. The children who had been receiving increasingly higher doses of milk protein over a few months were able to tolerate a median dose of 5, 140 mg (over 5 ounces) of milk without having any allergic reaction or with mild symptoms, such as mouth itching and minor abdominal discomfort. Those who had been getting the placebo remained unable to tolerate doses higher than the 40 mg of milk powder without having an allergic reaction. In the group receiving milk protein, the lowest tolerance dose was 2, 540 mg (2.5 ounces) and the highest was 8,140 mg (8 ounces). Lab tests showed the children who regularly drank or ate milk had more antibodies to milk in their blood, yet were able to better tolerate milk than those who took the placebo. Researchers say, tolerance in children treated with milk continued to build over time, and recommend that these children continue to consume milk daily to maintain their resistance. The researchers caution that it remains unclear whether the children would maintain their tolerance once they stop consuming milk regularly. "It may very well be that this tolerance is lost once the immune system is no longer exposed to the allergen daily," Wood says.
The Hopkins group is currently studying oral immunotherapy in children with egg allergy to determine whether increasingly higher doses of egg protein can help resolve their allergy, and have recently started another study of milk immunotherapy.
Wood emphasizes the findings require further research and advises parents and caregivers not to try oral immunotherapy without medical supervision.
Other Hopkins investigators in the study: Justin Skripak, M.D., Hannah Rowley, R.D., Nga Brereton, R.D., Susan Oh, R.D., Robert Hamilton, M.D., Elizabeth Matsui, M.D. M.H.S.
Duke University co-investigators: Scott Nash, M.D., and A. Wesley Burks, M.D.
The research was funded by the National Institutes of Health and The Eudowood Foundation.
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