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Takahashi Y, Deshpande GA, Kanai Y, Seok Yan K, Naito T. RS3PE Syndrome with Subsequent PMR Caused by Long-Term DPP-4 Inhibitor Use. Eur J Case Rep Intern Med 2023; 10:003914. [PMID: 37455697 PMCID: PMC10348439 DOI: 10.12890/2023_003914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/23/2023] [Indexed: 07/18/2023] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome has been reported in patients treated with dipeptidyl peptidase-4 inhibitors (DPP-4i). We experienced a case of RS3PE syndrome in a 73-year-old man with a history of type 2 diabetes, who developed RS3PE as a side effect of vildagliptin. Further to this, the patient developed polymyalgia rheumatica (PMR), the first such case associated with long-term DPP-4i use. LEARNING POINTS RS3PE syndrome and PMR are rare diseases that cause painful extremities in adults. We need to know if it occurs by DPP-4i.RS3PE syndrome and PMR can be complicated with malignancy or giant cell arteritis. However, we must rule out side effects of drugs at first from the standpoint of medical resources.
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Affiliation(s)
- Yuichi Takahashi
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Gautam A Deshpande
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshinori Kanai
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kwang Seok Yan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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2
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Borges T, Silva S. RSЗPE Syndrome: Autoinflammatory Features of a Rare Disorder. Mod Rheumatol 2022:6651678. [PMID: 35904275 DOI: 10.1093/mr/roac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/28/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022]
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RSЗPE) syndrome was first described by McCarty in 1985 and is characterized by pitting edema and an acute symmetrical synovitis of small joints. Self-directed inflammation in autoimmune disorders is caused by an abnormal activation of the adaptive immune system, while in autoinflammatory disorders is due to aberrant activation of the innate immune system without autoantibodies or autoreactive T cells. The role of autoimmunity in the pathogenesis of RSЗPE syndrome is suggested by possible associations with some autoimmune diseases and HLA haplotypes. However, several other features point to a possible role of autoinflammation in RSЗPE syndrome. In this review, the relative contributions of both innate and adaptive immune systems to the pathogenesis of RSЗPE syndrome are discussed.
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3
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Masuko K. Glucose as a Potential Key to Fuel Inflammation in Rheumatoid Arthritis. Nutrients 2022; 14:nu14112349. [PMID: 35684149 PMCID: PMC9182926 DOI: 10.3390/nu14112349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Glucose is the most important source of energy and homeostasis. Recent investigations are clarifying that glucose metabolism might be altered in rheumatoid arthritis (RA), which would play a role in the inflammatory phenotype of rheumatoid synovial fibroblasts. It may also play a role in a variety of autoimmune diseases’ pathophysiology by modulating immune responses and modifying autoantigen expressions. The research into glucose and its metabolism could lead to a better understanding of how carbohydrates contribute to the occurrence and duration of RA and other autoimmune diseases.
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Affiliation(s)
- Kayo Masuko
- Department of Internal Medicine, Akasaka Sanno Medical Center, Tokyo 107-8402, Japan; ; Tel.: +81-3-6230-3701; Fax: +81-3-6230-3702
- Clinical Research Center, International University of Health and Welfare, Tokyo 107-8402, Japan
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4
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Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome Worsen after the Administration of Dulaglutide. Medicina (B Aires) 2022; 58:medicina58020289. [PMID: 35208612 PMCID: PMC8876704 DOI: 10.3390/medicina58020289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical polyarthritis and limb pitting edema. Although the detailed mechanisms of this syndrome have not been clearly understood, some agents including dipeptidyl peptidase-4 inhibitors have been reported to induce RS3PE syndrome. However, glucagon-like peptide-1 (GLP-1) analogues have not been reported to be associated with this syndrome. A 91-year-old woman was admitted to our hospital with complaints of severe polyarthritis and limb edema. She was diagnosed with RS3PE syndrome. Oral prednisolone improved her symptoms. However, her symptoms worsened after the administration of dulaglutide, with elevated serum inflammatory markers. Discontinuation of dulaglutide without additional treatment improved her symptoms and laboratory findings. This case might indicate the possibility of development and worsening of RS3PE syndrome caused after GLP-1 analogue.
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5
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Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome: A Single-Center Experience. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.964824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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6
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Aung TKK, Chuah TY, Chua MWJ. More Than Meets the Eye: A Patient with Hand Swelling and Newly Diagnosed Diabetes Mellitus. Am J Med 2021; 134:1357-1361. [PMID: 34102158 DOI: 10.1016/j.amjmed.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Tyng Yu Chuah
- Department of General Medicine (Rheumatology), Sengkang General Hospital, Singapore
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7
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Horai Y, Shimizu T, Okada A, Tokumitsu J, Ikeoka T, Kuriya G, Iwanaga N, Izumi Y, Origuchi T, Kawakami A. Dipeptidyl peptidase-4 inhibitor use is associated with a lower erythrocyte sedimentation rate in patients with remitting seronegative symmetrical synovitis with pitting oedema and pre-existing diabetes mellitus. Mod Rheumatol 2021; 32:830-833. [PMID: 34908128 DOI: 10.1093/mr/roab036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Akitomo Okada
- Department of Rheumatology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Junichi Tokumitsu
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan.,Diabetes Center, Sasebo Chuo Hospital, Nagasaki, Sasebo, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Nagasaki, Omura, Japan
| | - Tomoki Origuchi
- Unit of Translational Medicine, Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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8
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Law J, Nauka PC, Nguyen A, LeFrancois D. Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Associated with DPP-4 Inhibitor. Am J Med 2021; 134:e412-e414. [PMID: 33621536 DOI: 10.1016/j.amjmed.2021.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jammie Law
- Department of Medicine, Montefiore Medical Center, Bronx, NY.
| | - Peter C Nauka
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Andy Nguyen
- Department of Medicine, Montefiore Medical Center, Bronx, NY
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9
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Lakhmalla M, Dahiya DS, Kichloo A, Fatima T, Edigin E, Wani F. Remitting seronegative symmetrical synovitis with pitting edema: a review. J Investig Med 2020; 69:86-90. [DOI: 10.1136/jim-2020-001613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/23/2022]
Abstract
Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare benign rheumatological condition characterized by sudden-onset symmetrical distal extremity edema. It can present as an isolated disease process or could be associated with other conditions. Rheumatoid factor and anticitrullinated protein antibodies are negative by definition. In current literature, there is paucity of data about the disease process. We performed a literature search using the PubMed database to identify 38 articles that met our inclusion and exclusion criteria. Our literature review focuses on the clinical picture and its diverse associations. Role of various acute phase reactants has also been outlined. There is a generalized consensus among clinicians on using moderate dose steroids for treatment. Other management options for refractory cases have also discussed. Value of several imaging modalities in diagnostic evaluation of this disease entity is touched on. Since RS3PE can be associated with other diseases, specifically cancer, timely diagnosis of this condition is necessary.
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10
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Chen YC, Chen TH, Sun CC, Chen JY, Chang SS, Yeung L, Tsai YW. Dipeptidyl peptidase-4 inhibitors and the risks of autoimmune diseases in type 2 diabetes mellitus patients in Taiwan: a nationwide population-based cohort study. Acta Diabetol 2020; 57:1181-1192. [PMID: 32318876 PMCID: PMC7173685 DOI: 10.1007/s00592-020-01533-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
AIMS Dipeptidyl peptidase-4, a transmembrane glycoprotein expressed in various cell types, serves as a co-stimulator molecule to influence immune response. This study aimed to investigate associations between DPP-4 inhibitors and risk of autoimmune disorders in patients with type 2 diabetes mellitus in Taiwan. METHODS This retrospective cohort study used the nationwide data from the diabetes subsection of Taiwan National Health Insurance Research Database between January 1, 2009, and December 31, 2013. Cox proportional hazards models were developed to compare the risk of autoimmune disorders and the subgroup analyses between the DPP-4i and DPP-4i-naïve groups. RESULTS A total of 774,198 type 2 diabetic patients were identified. The adjusted HR of the incidence for composite autoimmune disorders in DPP-4i group was 0.56 (95% CI 0.53-0.60; P < 0.001). The subgroup analysis demonstrated that the younger patients (aged 20-40 years: HR 0.47, 95% CI 0.35-0.61; aged 41-60 years: HR 0.50, 95% CI 0.46-0.55; aged 61-80 years: HR 0.63, 95% CI 0.58-0.68, P = 0.0004) and the lesser duration of diabetes diagnosed (0-5 years: HR 0.48, 95% CI 0.44-0.52; 6-10 years: HR 0.48, 95% CI 0.43-0.53; ≧ 10 years: HR 0.86, 95% CI 0.78-0.96, P < 0.0001), the more significant the inverse association of DPP-4 inhibitors with the incidence of composite autoimmune diseases. CONCLUSIONS DPP-4 inhibitors are associated with lower risk of autoimmune disorders in type 2 diabetes mellitus patients in Taiwan, especially for the younger patients and the lesser duration of diabetes diagnosed. The significant difference was found between the four types of DPP-4 inhibitors and the risk of autoimmune diseases. This study provides clinicians with useful information regarding the use of DPP-4 inhibitors for treating diabetic patients.
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Affiliation(s)
- Yi-Chuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shy-Shin Chang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling Yeung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yi-Wen Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Family Medicine, Chang Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Road, Keelung, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
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11
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Hirota Y, Suwanai H, Yamauchi T, Kadowaki T. Clinical Features of Type B Insulin Resistance in Japanese Patients: Case Report and Survey-Based Case Series Study. J Diabetes Res 2020; 2020:4359787. [PMID: 32337291 PMCID: PMC7166280 DOI: 10.1155/2020/4359787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022] Open
Abstract
Type B insulin resistance (TBIR) is an extremely rare disease characterized by marked hyperglycemia and insulin resistance and often coexists with autoimmune diseases. The characteristics, symptoms, blood glucose patterns, comorbidities, and treatments of TBIR all vary and are not defined. In this study, we described a case of TBIR that developed 6 months after DPP-4 inhibitor administration and immediately after the patient caught a cold. Treatment using prednisolone and insulin-like growth factor-1 was effective. We also conducted an observational survey-based case series study in a Japanese cohort comprising 21 cases. The average age of onset of TBIR was 62.3 ± 14.8 (17-84) years, and 61.9% of subjects were male. The majority of patients (90.4%) were 50 years old and over. During the study period, there was a high percentage (85.7%) of episodes of hypoglycemia, which was the trigger for diagnosis in more than 50% of cases. Glycemic patterns included 7 cases of hyperglycemia (33.3%), 10 cases of hypoglycemia (47.6%), and 4 cases of both hyperglycemia and hypoglycemia (19.1%). In the hypoglycemic group, 90.0% of patients were male. Furthermore, 71.4% of cases were antinuclear antibody positive, and 81.0% of cases were complicated with autoimmune disease. Systemic lupus erythematosus (38.1%) and Sjögren's syndrome (23.8%) were relatively common as coexisting autoimmune diseases. Treatment was based on prednisolone use, which was used in 88.9% of patients. On the other hand, the effect of IGF-1 was limited. Overall, the prognosis of TBIR was good.
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Affiliation(s)
- Yusuke Hirota
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hirotsugu Suwanai
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Department of Metabolism and Nutrition, Mizonokuchi Hospital, Teikyo University, Kanagawa 213-8507, Japan
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12
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Joseph AD, Kumanan T, Aravinthan N, Suganthan N. An unusual case of remitting seronegative symmetrical synovitis with pitting edema: Case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20910920. [PMID: 32215210 PMCID: PMC7081466 DOI: 10.1177/2050313x20910920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 01/30/2020] [Indexed: 11/25/2022] Open
Abstract
Remitting seronegative symmetrical synovitis with pitting edema is a rare but well-recognized clinical entity that is easily overlooked due to lack of clinical vigilance. It is classically described as an acute onset of symmetrical tenosynovitis of both upper and lower extremities with pitting edema, mostly noted in elderly population. Young patients with other rheumatological diseases and unilateral involvement had also been reported, but symmetrical remitting seronegative symmetrical synovitis with pitting edema in a young patient is a rare observation. We hereby report a case of a remitting seronegative symmetrical synovitis with pitting edema in a young male affected by no rheumatological diseases in the past, typically fulfilling the diagnostic criteria and well responded to low-dose steroid therapy. The salient features of the present case in terms of age, remitting seronegative symmetrical synovitis with pitting edema possibly related to undifferentiated arthropathy, reactive arthritis, or diabetes mellitus.
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Affiliation(s)
- Anne Dd Joseph
- University Medical Unit, Teaching Hospital, Jaffna, Sri Lanka
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13
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Moreno Obregón F, Del Castillo Madrigal M, Díaz Narváez F, Pérez Delgado FJ. RS3PE syndrome with positive rheumatoid factor. REUMATOLOGIA CLINICA 2019; 15:e168-e169. [PMID: 29254743 DOI: 10.1016/j.reuma.2017.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/02/2017] [Accepted: 11/10/2017] [Indexed: 06/07/2023]
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14
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Horai Y, Origuchi T, Iwanaga N, Tokumitsu J, Ikeoka T, Kuriya G, Izumi Y, Kawakami A. Clinical analysis of pre-existing diabetes mellitus and dipeptidyl peptidase-4 inhibitors in patients with remitting seronegative symmetrical synovitis and pitting edema syndrome. Mod Rheumatol 2019; 30:703-707. [PMID: 31500483 DOI: 10.1080/14397595.2019.1666463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: To analyze the association among remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, diabetes mellitus (DM), and antidiabetic drugs.Methods: We retrospectively analyzed the clinical and serologic manifestations of patients who had RS3PE syndrome with and without pre-existing DM. Then we performed a subanalysis in which patients with pre-existing DM were classified into two groups according to whether they were or were not taking a dipeptidyl peptidase 4 inhibitor (DPP4i), an antidiabetic drug that was suggested to have an association with the pathogenesis of RS3PE syndrome.Results: Pre-existing DM was found in 13 (35.1%) of 37 patients with RS3PE syndrome. No significant differences in age, gender, physical manifestations, and laboratory findings were observed between the patients with DM and those without DM. DPP4i had been administered to 6 of 13 patients with RS3PE and pre-existing DM. We observed no significant differences in manifestations of RS3PE syndrome before treatment; however, one relapse occurred in a patient with poorly controlled DM who had been continuing DPP4i therapy.Conclusion: This study revealed no evidence suggesting an association among RS3PE syndrome, DM, and antidiabetic drugs. DPP4i would be safe for use by most of patients with RS3PE syndrome. However, elderly patients and patients with poorly controlled DM might require careful observation.
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Affiliation(s)
- Yoshiro Horai
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Tomoki Origuchi
- Unit of Translational Medicine, Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Junichi Tokumitsu
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Toshiyuki Ikeoka
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Genpei Kuriya
- Department of Endocrinology and Metabolism, National Hospital Organization Nagasaki Medical Center, Omura, Japan.,Diabetes Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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15
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Wang CY, Fu SH, Yang RS, Hsiao FY. Use of dipeptidyl peptidase-4 inhibitors and the risk of arthralgia: Population-based cohort and nested case-control studies. Pharmacoepidemiol Drug Saf 2019; 28:500-506. [PMID: 30724413 DOI: 10.1002/pds.4733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/30/2018] [Accepted: 12/17/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The objective of this study was to investigate the association between the administration of dipeptidyl peptidase-4 (DPP-4) inhibitors (cumulative duration, timing, and individual substance) and the risk of arthralgia by using a nationwide database with two methodological approaches including cohort and nested case-control study designs. METHODS Using Taiwan's National Health Insurance Research Database, we identified patients who were newly prescribed with DPP-4 inhibitors, thiazolidinediones (TZDs), or acarbose between 1 March 2009 and 31 December 2012. The exposure of studied drugs was categorized into five exclusive categories: DPP-4 inhibitor, TZD, acarbose, combined use, or non-use, and assessed in a time-varying manner. Time-dependent Cox proportional hazard models were used to estimate the association between DPP-4 inhibitors and the risk of arthralgia. Particularly, we tested the impact of different cumulative duration, timing, and individual substance of DPP-4 inhibitors use on risk of arthralgia. A corresponding nested case-control study using conditional logistic regression was conducted to verify this association. RESULTS An increased risk of arthralgia was observed during the first year after initiating DPP-4 inhibitors (adjusted Hazard Ratio = 1.35; 95% confidence interval [CI], 1.04-1.75) but the risk declined with cumulative use. This duration-response relation was not found in TZDs use and acarbose use. In the nested case-control study, there was a slightly increased risk of arthralgia (aOR = 1.08; 95% CI, 1.04-1.12) associated with current DPP-4 inhibitor use. CONCLUSION A relatively higher risk of arthralgia was associated with the initial administration of DPP-4 inhibitors, however, the risk declined among long-term users.
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Affiliation(s)
- Chen-Yu Wang
- Graduate Institute of Clinical Pharmacy, National Taiwan University, College of Medicine, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shau-Huai Fu
- Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, National Taiwan University, College of Medicine, Taipei, Taiwan.,School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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16
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Ngo L, Miller E, Valen P, Gertner E. Nivolumab induced remitting seronegative symmetrical synovitis with pitting edema in a patient with melanoma: a case report. J Med Case Rep 2018; 12:48. [PMID: 29478412 PMCID: PMC6389137 DOI: 10.1186/s13256-018-1579-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/21/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Novel immune checkpoint inhibitors have been often utilized for different types of malignancies as salvage therapy with varying success. One obstacle to immune checkpoint inhibitor use is the higher incidence of immune-mediated side effects that can prompt discontinuation of therapy. Remitting seronegative symmetrical synovitis with pitting edema has been described with immune checkpoint inhibitors only once previously. We report a case of a patient who developed remitting seronegative symmetrical synovitis with pitting edema related to immune checkpoint inhibitor therapy and stress that these symptoms can be managed without cessation of immune checkpoint inhibitor therapy. CASE PRESENTATION We present a 70-year-old white man who presented with 4 months of progressive inflammatory arthritis with pitting edema. He had been started on nivolumab therapy for his metastatic melanoma with excellent response prior to symptom onset. The symptoms started in his knees and subsequently involved both hands and feet. On evaluation, he was wheelchair bound and completely dependent for all activities of daily living. Evaluation revealed negative serological testing and plain film imaging. Ultrasound demonstrated diffuse flexor tenosynovitis and soft tissue swelling, and a diagnosis of remitting seronegative symmetrical synovitis with pitting edema was made. He was treated with orally administered corticosteroids (0.5 mg/kg per day) which improved his symptoms significantly and allowed him to regain prior independent functioning. His corticosteroids were tapered (0.15 mg/kg per day) but not discontinued and his nivolumab treatment was not interrupted. In follow up he continued to have stable control of his melanoma as well as his remitting seronegative symmetrical synovitis with pitting edema. CONCLUSIONS In conclusion we present the first case of nivolumab-induced remitting seronegative symmetrical synovitis with pitting edema that is controlled by maintenance low-dose orally administered corticosteroids allowing for continuation of nivolumab therapy. Clinicians who encounter mild-to-moderate immune checkpoint inhibitor immune-mediated adverse effects can consider maintaining immune checkpoint inhibitor therapy with concomitant low-dose corticosteroids rather than abrupt cessation of the immune checkpoint inhibitor.
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Affiliation(s)
- Linh Ngo
- University of Minnesota, Medicine Rheumatology Office, D615Mayo, 420 Delaware St SE, Minneapolis, MN 55455-034 USA
| | - Eric Miller
- Hennepin County Medical Center, Minneapolis, USA
| | - Peter Valen
- Minneapolis VA Medical Center, University of Minnesota, Minneapolis, USA
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Kathe N, Shah A, Said Q, Painter JT. DPP-4 Inhibitor-Induced Rheumatoid Arthritis Among Diabetics: A Nested Case-Control Study. Diabetes Ther 2018; 9:141-151. [PMID: 29236221 PMCID: PMC5801239 DOI: 10.1007/s13300-017-0353-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The risk of rheumatoid arthritis (RA) associated with dipeptidyl peptidase-4 inhibitor (DPP-4i) use is unclear. This study assesses the RA risk associated with DPP-4i use among a diabetic cohort initiating second-line therapy. METHODS This was a nested case-control study, using the adult diabetic population starting second-line antidiabetic therapy from IMS LifeLink Plus® database (2006-2015). Cases were those with two or more RA diagnosis, at least one prescription, and 180 days enrollment prior to the event date (earliest of the two: first RA diagnosis, first RA prescription). Controls were drawn from the nest after matching (1:15) with cases on index date (± 90 days), age (± 5 years), sex, and event date (imputed to have the same time difference between cohort entry and event date as the matched case). Exposure and covariate information was gathered from the 180-day period prior to event date. Conditional logistic regression was used to assess exposure among cases and controls. Adjusted analysis was carried out after controlling for important medications and comorbidities. RESULTS The final sample consists of 790 cases and 11,850 controls; of these, 151 cases (19.11%) and 2177 controls (18.37%) had DPP-4i claims during the exposure assessment period. DPP-4i therapy was not significantly associated with the development of RA after adjusting for covariates (OR = 1.156, 95% CI 0.936-1.429). Changing the exposure definition or exposure window to 1 year and subgroup analyses yielded similar results except for the non-insulin-using subgroup (OR = 1.299, 95% CI 1.001-1.985) which showed a significant positive association. CONCLUSION DPP-4i were not significantly associated with the risk of RA compared with other second-line antidiabetic therapies.
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Affiliation(s)
- Niranjan Kathe
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Anuj Shah
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Qayyim Said
- Health Economics and Outcomes Research, Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Jacob T Painter
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
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Liu C, Zhong C, Zhou X, Chen R, Wu J, Wang W, Li X, Ding H, Guo Y, Gao Q, Hu X, Xiong G, Yang X, Hao L, Xiao M, Yang N. Higher direct bilirubin levels during mid-pregnancy are associated with lower risk of gestational diabetes mellitus. Endocrine 2017; 55:165-172. [PMID: 27726090 DOI: 10.1007/s12020-016-1103-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/24/2016] [Indexed: 12/16/2022]
Abstract
Bilirubin concentrations have been recently reported to be negatively associated with type 2 diabetes mellitus. We examined the association between bilirubin concentrations and gestational diabetes mellitus. In a prospective cohort study, 2969 pregnant women were recruited prior to 16 weeks of gestation and were followed up until delivery. The value of bilirubin was tested and oral glucose tolerance test was conducted to screen gestational diabetes mellitus. The relationship between serum bilirubin concentration and gestational weeks was studied by two-piecewise linear regression. A subsample of 1135 participants with serum bilirubin test during 16-18 weeks gestation was conducted to research the association between serum bilirubin levels and risk of gestational diabetes mellitus by logistic regression. Gestational diabetes mellitus developed in 8.5 % of the participants (223 of 2969). Two-piecewise linear regression analyses demonstrated that the levels of bilirubin decreased with gestational week up to the turning point 23 and after that point, levels of bilirubin were increased slightly. In multiple logistic regression analysis, the relative risk of developing gestational diabetes mellitus was lower in the highest tertile of direct bilirubin than that in the lowest tertile (RR 0.60; 95 % CI, 0.35-0.89). The results suggested that women with higher serum direct bilirubin levels during the second trimester of pregnancy have lower risk for development of gestational diabetes mellitus.
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Affiliation(s)
- Chaoqun Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Chunrong Zhong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xuezhen Zhou
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Renjuan Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Jiangyue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Weiye Wang
- Departments of Epidemiology and Health Statistic, Wuhan, China
| | - Xiating Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Huisi Ding
- Departments of Epidemiology and Health Statistic, Wuhan, China
| | - Yanfang Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Qin Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Xingwen Hu
- Hubei Maternal and Child Health Hospital, Wuhan, 430070, Hubei, China
| | - Guoping Xiong
- The Central Hospital of Wuhan, Wuhan, 430014, Hubei, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Mei Xiao
- Hubei Maternal and Child Health Hospital, Wuhan, 430070, Hubei, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
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Dipeptidyl Peptidase (DPP)-4 Inhibitor-Induced Arthritis/Arthralgia: A Review of Clinical Cases. Drug Saf 2016; 39:401-7. [PMID: 26873369 DOI: 10.1007/s40264-016-0399-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Dipeptidyl peptidase (DPP)-4 inhibitors are a class of oral drugs used for the treatment of type 2 diabetes mellitus (T2DM). The pharmacological inhibition of DPP-4 seems to also induce adverse events related to cytokine-induced inflammation. Recently, several clinical cases regarding the association of DPP-4 inhibitors and the onset of arthritis/arthralgia have been reported in the literature. Various mechanisms could be responsible for DPP-4 inhibitor-induced arthritis/arthralgia, and the increase of cytokines, chemokines, matrix metalloproteinases (MMPs) and genetic factors plays an important role. The US FDA published a safety announcement regarding the entire drug class, encouraging healthcare professionals and patients to pay attention to the occurrence of arthralgia during treatment with DPP-4 inhibitors; arthralgia could be assessed as a class adverse drug event for DPP-4 inhibitors. To summarize the evidence on the correlation between DPP-4 inhibitors and arthritis/arthralgia, and to explain the measures taken by the FDA with regard to arthralgia risk, we performed a literature review of recent evidence concerning this association. This review shows the necessity of other studies to better define the association between DPP-4 inhibitors and arthritis/arthralgia.
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Dipeptidyl Peptidase-4 Inhibitor Increases Vascular Leakage in Retina through VE-cadherin Phosphorylation. Sci Rep 2016; 6:29393. [PMID: 27381080 PMCID: PMC4933943 DOI: 10.1038/srep29393] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/16/2016] [Indexed: 12/13/2022] Open
Abstract
The inhibitors of CD26 (dipeptidyl peptidase-4; DPP4) have been widely prescribed to control glucose level in diabetic patients. DPP4-inhibitors, however, accumulate stromal cell-derived factor-1α (SDF-1α), a well-known inducer of vascular leakage and angiogenesis both of which are fundamental pathophysiology of diabetic retinopathy. The aim of this study was to investigate the effects of DPP4-inhibitors on vascular permeability and diabetic retinopathy. DPP4-inhibitor (diprotin A or sitagliptin) increased the phosphorylation of Src and vascular endothelial-cadherin (VE-cadherin) in human endothelial cells and disrupted endothelial cell-to-cell junctions, which were attenuated by CXCR4 (receptor of SDF-1α)-blocker or Src-inhibitor. Disruption of endothelial cell-to-cell junctions in the immuno-fluorescence images correlated with the actual leakage of the endothelial monolayer in the transwell endothelial permeability assay. In the Miles assay, vascular leakage was observed in the ears into which SDF-1α was injected, and this effect was aggravated by DPP4-inhibitor. In the model of retinopathy of prematurity, DPP4-inhibitor increased not only retinal vascularity but also leakage. Additionally, in the murine diabetic retinopathy model, DPP4-inhibitor increased the phosphorylation of Src and VE-cadherin and aggravated vascular leakage in the retinas. Collectively, DPP4-inhibitor induced vascular leakage by augmenting the SDF-1α/CXCR4/Src/VE-cadherin signaling pathway. These data highlight safety issues associated with the use of DPP4-inhibitors.
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Amodeo M, Poyato M, Rodríguez M. El síndrome RS3PE: actualización de su tratamiento a propósito de un caso. Semergen 2015; 41:429-34. [DOI: 10.1016/j.semerg.2015.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/23/2015] [Accepted: 03/28/2015] [Indexed: 11/27/2022]
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Oyama K, Taniguchi JI, Goto R, Matsui K. Remitting seronegative symmetrical synovitis with pitting edema syndrome in individuals with type 2 diabetes mellitus or impaired glucose tolerance. Diabetes Res Clin Pract 2015; 110:e5-e8. [PMID: 26293448 DOI: 10.1016/j.diabres.2015.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/28/2015] [Indexed: 11/29/2022]
Abstract
An association between remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and insulin or dipeptidyl peptidase-4 (DPP4) inhibitor therapy were previously reported. We encountered four cases of RS3PE syndrome with type 2 diabetes mellitus or impaired glucose tolerance (IGT) without insulin or DPP4 inhibitor medication.
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Affiliation(s)
- Kohta Oyama
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan
| | - Jun-Ichi Taniguchi
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan.
| | - Rieko Goto
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan
| | - Kunihiko Matsui
- Center for Community and General Medicine, Kumamoto University Hospital, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 8608556, Japan
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Mainali NR, Schmidt TR, Alweis R, George DL. Novel Development of Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) Syndrome due to Insulin Therapy. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:119-22. [PMID: 24696753 PMCID: PMC3972051 DOI: 10.12659/ajcr.890318] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/10/2014] [Indexed: 12/14/2022]
Abstract
PATIENT Male, 67 FINAL DIAGNOSIS: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome Symptoms: Bilateral wrist swelling Medication: - Clinical Procedure: - Specialty: Rheumatology. OBJECTIVE Unusual or unexpected effect of treatment. BACKGROUND Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare clinical entity characterized by the sudden onset of inflammatory arthritis and marked pitting edema on upper and lower extremities. RS3PE is considered a rheumatic process distinct from rheumatoid arthritis, which may occasionally represent a paraneoplastic syndrome. CASE REPORT Herein, we describe a rare case of RS3PE associated with insulin therapy in a patient with no evidence of underlying malignancy. CONCLUSIONS To the best of our knowledge, this is the first case report of RS3PE associated with insulin therapy. Physicians should look at the introduction of drugs as possible triggers for the development of RS3PE.
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Affiliation(s)
- Naba Raj Mainali
- Department of Internal Medicine, Reading Health System, West Reading, PA, U.S.A
| | - Torrey R Schmidt
- Department of Internal Medicine, Robert Wood Johnson University Hospital, New Brunswick, NJ, U.S.A
| | - Richard Alweis
- Department of Internal Medicine, Reading Health System, West Reading, PA, U.S.A. ; Jefferson Medical College, Philadelphia, PA, U.S.A
| | - David L George
- Department of Internal Medicine, Reading Health System, West Reading, PA, U.S.A. ; Jefferson Medical College, Philadelphia, PA, U.S.A
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Tarapués M, Cereza G, Figueras A. Association of musculoskeletal complaints and gliptin use: review of spontaneous reports. Pharmacoepidemiol Drug Saf 2013; 22:1115-8. [PMID: 23960039 DOI: 10.1002/pds.3503] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 07/19/2013] [Accepted: 07/25/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Gliptins are new oral antidiabetic drugs that increase insulin levels through dipeptidyl peptidase-4 inhibition. Recently, the association of serious musculoskeletal (MSk) adverse effects with the gliptin use has been suggested. The aim is to describe and analyze the characteristics of spontaneous reports related to these adverse effects and gliptin use. METHODS All spontaneous reports with MSk disorders associated with gliptins gathered in the Spanish pharmacovigilance database until May 2012 were described and analyzed using a case/non-case method. RESULTS Gliptins were reported as the suspected drug in 332 cases: 208 involved sitagliptin, 115 vildagliptin, and nine saxagliptin. In 34 patients (10.2% of total reports with gliptins), MSk reactions were described (22 women [64.7%] and 12 men [35.3%]). Their mean age was 65.1 years; 41.2% were younger than 65 years. Only seven cases were serious, but the gliptin had to be withdrawn in 22 patients because of intolerance and/or persistence of MSk discomfort, and patients recovered after its discontinuation. A positive re-challenge was observed in two cases. In seven cases, the patients were on previous chronic treatment with statins, and began to present MSk complaints shortly after starting a gliptin. The reporting odds ratio (ROR) for myalgia and arthralgia were strongly associated with gliptin use (ROR 1.96 [95% CI 1.12-3.43], p < 0.05 and ROR 2.69 [95% CI 1.38-5.24], p < 0.05, respectively). CONCLUSIONS Musculoskeletal disorders are adverse reactions strongly associated with gliptins that, despite not being serious, may impair the treatment adherence in patients with type 2 diabetes. Future observational studies could confirm these findings.
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Affiliation(s)
- Mónica Tarapués
- Pharmacology, Therapeutics and Toxicology Department, Universitat Autònoma de Barcelona, Bellaterra, (Cerdanyola del Vallès), Spain
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DPP4 inhibitor-induced polyarthritis: a report of three cases. Rheumatol Int 2013; 34:291-2. [PMID: 23462883 DOI: 10.1007/s00296-013-2710-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/19/2013] [Indexed: 12/21/2022]
Abstract
Dipeptidyl peptidase-4 (DPP4) inhibitors are a novel therapy widespread used in type 2 diabetes mellitus. We describe 3 cases of polyarthritis which delay of appearance strongly suggests a link with DPP4 inhibitors. Three patients presented with bilateral, symmetrical, seronegative polyarthritis after introduction of DPP4 inhibitors (sitagliptine (n = 2) and vildagliptine (n = 1)). Two patients also developed xerostomia and xerostomia, and laboratory test results showed normal values of CRP and erythrocyte sedimentation rate. Joints X-rays were normal. One patient was diagnosed with primary Sjögren's syndrome and treated with hydroxychloroquine, methotrexate and prednisone, with a poor efficacy. When sitagliptine was stopped, all symptoms disappeared, leading to methotrexate and prednisone discontinuation within a month. There were no immunological abnormalities in the 2 other patients, but a chronic viral hepatitis B was found in one patient. Eventually, discontinuation of DPP4 inhibitors led to resolution of symptoms in 1 and 3 weeks for both patients. DPP4 inhibitors seemed to trigger bilateral, non-erosive, seronegative polyarthritis in our 3 patients. DPP4, also known as CD26, is expressed on many cells including lymphocytes and fibroblasts, and its inhibition may lead to immunomodulating effect as suggested by clinical and in vitro studies.
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First reports of serious adverse drug reactions in recent weeks. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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