The Risk of TB in Patients With Type 2 Diabetes Initiating Metformin vs Sulfonylurea Treatment

Pan, Shiann; Yen, Yung‐Feng; Kou, Yu Ru; Chuang, Pei Hung; Su, Vin‐Cent; Feng, Jia; Chan, Yu Jiun; Su, Wei

doi:10.1016/j.chest.2017.11.040

Cited by 49 publications

(60 citation statements)

References 32 publications

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“…In contrast, our study included statin users and nonstatin users, who were the active‐drug comparator reference group, and used a time‐dependent method to assess the treatment effects given universal index dates on diabetes diagnosis . Moreover, we adjusted diabetes severity by aDCSI and metformin usage in the analysis because of their associations with TB risk even after exclusion of CKD . With these efforts, we demonstrated that statin users were associated with a 34% decreased risk of TB compared with nonstatin users.…”

Section: Discussionmentioning

confidence: 99%

“…Participants aged ≥20 years with a type 2 diabetes diagnosis that presented in ≥1 inpatient or ≥ 4 outpatient records ( International Classification of Diseases, 9th Revision, Clinical Modification [ICD‐9] codes: 250.x0 and 250.x2) without type 1 diabetes (codes: 250.x1 and 250.X3) were identified in records from 2000 to 2013 . All study participants were validated as having oral antidiabetic agent and/or injectable insulin prescriptions . The date of first‐time diabetes diagnosis was the index date.…”

Section: Methodsmentioning

confidence: 99%

“…A metformin early‐initiator was defined if a patient started ≥30 cDDD of metformin treatment in the initial 6 months after diabetes diagnosis. Income level was classified into 3 levels in this study, and urbanization was categorized into urban, suburban and rural areas . The comorbidities of interest were chronic obstructive pulmonary disease (ICD‐9 codes 491, 492, and 496) and/or asthma (code 493), malignancy (codes 140–208), liver cirrhosis (codes 571.2 and 571.5) and rheumatoid arthritis (code 714).…”

Section: Methodsmentioning

confidence: 99%

“…18 All study participants were validated as having oral antidiabetic agent and/or injectable insulin prescriptions. 19 The date of first-time diabetes diagnosis was the index date. Because participants should have a preceding year for comorbidities and comedication review, subjects with diabetes diagnosed during 2001-2013 were included and those in 2000 were excluded.…”

Section: Populationmentioning

confidence: 99%

“…19 The severity of diabetes at baseline was assessed with the adapted diabetes complication severity index (aDCSI) score, as previously used in claim-data studies. 19,26,34 Here, the aDCSI score was calculated by diabetes-related complications that presented in ≥2 outpatient or 1 inpatient records in the preceding and following years of diabetes diagnosis. A metformin earlyinitiator was defined if a patient started ≥30 cDDD of metformin treatment in the initial 6 months after diabetes diagnosis.…”

Section: Outcomes and Measurementmentioning

confidence: 99%

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Opposite effects of statins on the risk of tuberculosis and herpes zoster in patients with diabetes: A population‐based cohort study

Pan

Yen

Feng

et al. 2020

Brit J Clinical Pharma

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Aims It remains uncertain whether statin use is associated with the risks of tuberculosis (TB) and herpes zoster in patients with type 2 diabetes. This study aims to assess the effects of statins vs nonstatin lipid‐lowering agents on the risk of these infectious diseases in patients with diabetes. Methods Participants in the Taiwan National Health Insurance Research Database diagnosed with type 2 diabetes in 2001–2013 were classified as statin users, nonstatin users and lipid‐lowering drug‐free groups. Participants were observed for incident TB and herpes zoster from diabetes diagnosis until treatment crossover or December 2013. Statin user and nonstatin user were the time‐dependent variables in Cox regression analysis. Results Over 240 782 person‐years of observation, statin users (n = 17 696) were associated with a lower TB risk than nonstatin users (n = 5327) and the drug‐free group (n = 22 316) (adjusted hazard ratio [aHR]: 0.66; 95% confidence interval [CI]: 0.44–0.99 and aHR: 0.57; 95% CI: 0.44–0.73). Compared with nonstatin users, statin users showed a dose‐dependent association with TB risk (low‐potency statin users, aHR: 0.692; 95% CI: 0.455–1.053; high‐potency users, aHR: 0.491; 95% CI: 0.241–0.999). Statin users presented with a higher risk of herpes zoster than nonstatin users and the drug‐free group (aHR: 1.23; 95% CI: 1.01–1.50 and aHR: 1.20; 95% CI: 1.09–1.33). The risks of TB and herpes zoster were not statistically different between nonstatin users and the drug‐free group. Conclusion Compared with nonstatin drugs, statin use was specifically associated with a decreased risk of TB but a moderately increased risk of herpes zoster in this cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Populationmentioning

confidence: 99%

Section: Outcomes and Measurementmentioning

confidence: 99%

See 3 more Smart Citations

Opposite effects of statins on the risk of tuberculosis and herpes zoster in patients with diabetes: A population‐based cohort study

Pan

Yen

Feng

et al. 2020

Brit J Clinical Pharma

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Antitubercular Agents

Aldrich¹,

Wallis²,

Hegde³

et al. 2021

Burger's Medicinal Chemistry and Drug Discovery

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Mycobacterium tuberculosis remains the leading cause of death due to infection in humans. Although antibiotics are available to treat drug‐sensitive M. tuberculosis infections, the increasing incidence of drug‐resistant strains is threatening our ability to gain hold of this pandemic. In addition, recent research has highlighted that even the current standard of care antibiotics face multiple obstacles for reaching therapeutic concentrations at the site of infection. In this article, we detail the current standard of care for clinical tuberculosis (TB) disease, the chemistry, mechanisms of action, and mechanisms of resistance for the antibiotics used clinically to treat TB, the growing problem of antibiotic resistance, and other challenges associated with TB treatment, and host‐directed therapies as an additional approach to treatment. This article is meant to serve as the foundation to build from as the field addresses the dire need for continued development of new therapeutic strategies to treat TB.

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Effects of host‐directed therapies on the pathology of tuberculosis

Tsenova

Singhal

2020

The Journal of Pathology

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Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), has co-evolved with the human immune system and utilizes multiple strategies to persist within infected cells, to hijack several immune mechanisms, and to cause severe pathology and tissue damage in the host. This delays the efficacy of current antibiotic therapy and contributes to the evolution of multi-drug-resistant strains. These challenges led to the development of the novel approach in TB treatment that involves therapeutic targeting of host immune response to control disease pathogenesis and pathogen growth, namely, host-directed therapies (HDTs). Such HDT approaches can (1) enhance the effect of antibiotics, (2) shorten treatment duration for any clinical form of TB, (3) promote development of immunological memory that could protect against relapse, and (4) ameliorate the immunopathology including matrix destruction and fibrosis associated with TB. In this review we discuss TB-HDT candidates shown to be of clinical relevance that thus could be developed to reduce pathology, tissue damage, and subsequent impairment of pulmonary function.

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The Risk of TB in Patients With Type 2 Diabetes Initiating Metformin vs Sulfonylurea Treatment

Cited by 49 publications

References 32 publications

Opposite effects of statins on the risk of tuberculosis and herpes zoster in patients with diabetes: A population‐based cohort study

Opposite effects of statins on the risk of tuberculosis and herpes zoster in patients with diabetes: A population‐based cohort study

Antitubercular Agents

Effects of host‐directed therapies on the pathology of tuberculosis

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