Date: 27 March 2020
A drug used to treat type 2 diabetes, could offer a simple solution to reducing the dangerous side effects of steroid treatment.
The trial, funded by Barts Charity, and supported by the NIHR, looked at the effects of a diabetes drug, metformin, on patients currently receiving high doses of glucocorticoids, a type of steroids used to treat chronic inflammatory diseases.
Researchers analysed results from more than 50 non-diabetic patients on glucocorticoid treatment and found patients treated with metformin showed improved clinical outcomes.
The benefits found in the trial, included a 30 percent reduction in the rate of infections and lower hospital admissions. Researchers also observed that treatment strengthened the intended anti-inflammatory effects of glucocorticoids and had beneficial results on several cardiovascular, metabolic and bone markers over the 12-week trial period.
Since the discovery of their therapeutic effects in the 1950s, glucocorticoids, such as prednisolone, have revolutionised treatment of patients with inflammatory disease. They are now used to treat a range of conditions where the immune system is overactive, including rheumatoid arthritis, asthma, inflammatory diseases, and in cancer therapy.
However, prolonged use of these medicines at high doses can lead to serious side effects such as weight gain, high sugar levels, loss of bone and muscle mass, and increased risk of infection and thrombosis. Long-term, these features can lead to Cushing’s syndrome, a potentially fatal disorder.
It is estimated that around three percent of the general adult population and up to 11 percent of over 80s are currently prescribed long-term steroid treatment for chronic inflammatory disease.
Several biological medicines have been developed as alternatives to steroids, but these drugs are expensive and can present their own adverse effects.
The study, led by Professor Márta Korbonits and researchers from Queen Mary University of London and Barts Health NHS Trust has now been published in the journal The Lancet Diabetes & Endocrinology (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30021-8/fulltext).
Professor Korbonits said:
“Our findings are strikingly positive and suggest that a simple and immediately available intervention, treatment with the diabetes drug metformin, can improve the clinical status of patients on glucocorticoid treatment, even if they do not have diabetes. The results could have a huge impact on the large number of patients on long-term glucocorticoids, improving treatment-related complications and their cardiovascular prognosis.
“Whilst developed countries may be increasing the use of biologics or other steroid-sparing agents, in many other parts of the world there’s still a heavy reliance on glucocorticoids.
“Therefore, doctors and patients have been waiting for a safe, cheap and effective treatment that can prevent the major metabolic complications of these medicines, but does not affect, or could even improve, their anti-inflammatory properties. Our results suggest metformin has the potential to help these patients.”
It is hoped that the findings will lead to new, simple and cost-effective treatment options for patients and the NHS.