Associations Between Thiazolidinediones Use and Incidence of Rheumatoid Arthritis: A Retrospective Population‐Based Cohort Study

Abstract

ObjectivePreclinical studies suggest that thiazolidinediones (TZDs) may have a protective effect on rheumatoid arthritis (RA), but evidence from population‐based studies is scarce. This study aimed to assess the association between use of TZDs and incidence of RA in a retrospective cohort of patients with type 2 diabetes mellitus (T2DM).MethodsA retrospective cohort of patients with T2DM who were new users of TZDs or alpha glucosidase inhibitors (AGIs) was assembled. We applied the inverse probability of treatment weighted Cox model to estimate the hazard ratio (HR) of RA incidence associated with the use of TZDs compared with AGIs.ResultsThe final analysis included 56,796 new users of AGIs and 14,892 new users of TZDs. The incidence of RA was 187.4 and 135.2 per 100,000 person‐years in AGI users and TZD users, respectively. Compared with use of AGIs, TZD use was associated with a reduction in RA incidence, with an HR of 0.72 (95% confidence interval [95% CI] 0.59–0.89). HRs for cumulative use of TZDs for 0.51 to 4.0 years and more than 4 years with incidence of RA were 0.55 (95% CI 0.35–0.88) and 0.74 (95% CI 0.57–0.98), respectively. Various subgroup analyses and sensitivity analyses were consistent with the primary analysis.ConclusionUse of TZDs is associated with a decreased risk of incident RA in patients with T2DM.