In a new study, researchers found that a drug used to treat type 2 diabetes could offer a simple and cheap solution to reduce the dangerous side effects of steroid treatment.
The research was conducted by a team from the Queen Mary University of London.
It is estimated that around 3% of the general adult population and up to 11% of over 80s are currently prescribed long-term steroid treatment for chronic inflammatory disease.
The team looked at the effects of the diabetes drug metformin on patients currently receiving high doses of glucocorticoids, a type of steroids used to treat chronic inflammatory diseases.
Since the discovery of their therapeutic effects in the 1950s glucocorticoids, such as prednisolone, have revolutionized the treatment of patients with chronic inflammatory disease.
Now glucocorticoids are used to treat a range of conditions where the immune system is overactive, including rheumatoid arthritis, asthma, inflammatory diseases, and cancer therapy.
However, prolonged use of these medicines at high doses can lead to serious metabolic 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 that also exists in patients where the body makes too much of the stress hormone cortisol.
Several biological medicines have been developed as alternatives to steroids but these drugs are expensive and can present their own adverse effects.
In the study, the researchers analyzed results from over 50 non-diabetic patients on glucocorticoid treatment and found that patients treated with metformin showed improved clinical outcomes.
This included a 30% reduction in the rate of infections and lower hospital admissions, in comparison to the placebo group.
They also observed that treatment with metformin 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.
Previous studies have suggested that metformin acts, at least partly, via the AMPK protein and in the opposite way to steroids.
Based on this evidence, the researchers reasoned that the diabetes drug held the potential to reverse the unwanted side effects of steroids.
They say the findings are strikingly positive and provide 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 a large number of patients on long-term glucocorticoids, improving treatment-related complications and their cardiovascular prognosis.
One author of the study is Professor Márta Korbonits.
The study is published in the journal The Lancet Diabetes & Endocrinology.
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