PMID- 29385156 OWN - NLM STAT- MEDLINE DCOM- 20180222 LR - 20220410 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 13 IP - 1 DP - 2018 TI - Combination COX-2 inhibitor and metformin attenuate rate of joint replacement in osteoarthritis with diabetes: A nationwide, retrospective, matched-cohort study in Taiwan. PG - e0191242 LID - 10.1371/journal.pone.0191242 [doi] LID - e0191242 AB - BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis associated with an increased prevalence of type 2 diabetes mellitus (T2DM), however their impact on decreasing joint replacement surgery has yet to be elucidated. This study aimed to investigate if the combination of COX-2 inhibitor and metformin therapy in OA with T2DM were associated with lower the rate of joint replacement surgery than COX-2 inhibitor alone. METHODS: In total, 968 subjects with OA and T2DM under COX-2 inhibitor and metformin therapy (case group) between 1 January to 31 December 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 1936 patients were the 1:2 gender-, age-, and index year-controls matched without metformin therapy (control group) in this study. Cox proportional hazards analysis was used to compare the rate of receiving joint replacement surgery during 10 years of follow-up. RESULTS: At the end of follow-up, 438 of all enrolled subjects (15.08%) had received the joint replacement surgery, including 124 in the case group (12.81%) and 314 in the control group (16.22%). The case group tended to be associated with lower rate of receiving the joint replacement surgery at the end of follow-up than the control group (p = 0.003). Cox proportional hazards regression (HR) analysis revealed that study subjects under combination therapy with metformin had lower rate of joint replacement surgery (adjusted HR 0.742 (95% CI = 0.601-0.915, p = 0.005)). In the subgroups, study subjects in the combination metformin therapy who were female, good adherence (>80%), lived in the highest urbanization levels of residence, treatment in the hospital center and lower monthly insurance premiums were associated with a lower risk of joint replacement surgery than those without. CONCLUSIONS: Patients who have OA and T2DM receiving combination COX-2 inhibitors and metformin therapy associated with lower joint replacement surgery rates than those without and this may be attributable to combination therapy much more decrease pro-inflammatory factors associated than those without metformin therapy. FAU - Lu, Chieh-Hua AU - Lu CH AUID- ORCID: 0000-0002-2179-9486 AD - Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC. AD - Department of Medical Research, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Chung, Chi-Hsiang AU - Chung CH AD - School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. AD - Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, ROC. FAU - Lee, Chien-Hsing AU - Lee CH AD - Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Hsieh, Chang-Hsun AU - Hsieh CH AD - Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Hung, Yi-Jen AU - Hung YJ AD - Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Lin, Fu-Huang AU - Lin FH AD - School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Tsao, Chang-Huei AU - Tsao CH AD - Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC. AD - Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Hsieh, Po-Shiuan AU - Hsieh PS AD - Department of Medical Research, National Defense Medical Center, Taipei, Taiwan, ROC. AD - Department of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan, ROC. AD - Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan, ROC. FAU - Chien, Wu-Chien AU - Chien WC AD - Department of Medical Research, National Defense Medical Center, Taipei, Taiwan, ROC. AD - School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180131 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Cyclooxygenase 2 Inhibitors) RN - 0 (Hypoglycemic Agents) RN - 9100L32L2N (Metformin) SB - IM MH - Aged MH - Aged, 80 and over MH - *Arthroplasty, Replacement/statistics & numerical data MH - Cohort Studies MH - Cyclooxygenase 2 Inhibitors/*administration & dosage MH - Diabetes Mellitus, Type 2/*complications/*drug therapy MH - Drug Therapy, Combination MH - Female MH - Humans MH - Hypoglycemic Agents/*administration & dosage MH - Male MH - Metformin/*administration & dosage MH - Middle Aged MH - Osteoarthritis/*complications/*drug therapy/surgery MH - Proportional Hazards Models MH - Retrospective Studies MH - Taiwan PMC - PMC5791980 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2018/02/01 06:00 MHDA- 2018/02/23 06:00 PMCR- 2018/01/31 CRDT- 2018/02/01 06:00 PHST- 2017/06/11 00:00 [received] PHST- 2017/12/20 00:00 [accepted] PHST- 2018/02/01 06:00 [entrez] PHST- 2018/02/01 06:00 [pubmed] PHST- 2018/02/23 06:00 [medline] PHST- 2018/01/31 00:00 [pmc-release] AID - PONE-D-17-22286 [pii] AID - 10.1371/journal.pone.0191242 [doi] PST - epublish SO - PLoS One. 2018 Jan 31;13(1):e0191242. doi: 10.1371/journal.pone.0191242. eCollection 2018.