Differential Effects of Metformin on Immune-Mediated and Androgen-Mediated Non-Cancer Skin Diseases in Diabetes Patients: A Retrospective Cohort Study
Abstract
BACKGROUND: Metformin's effects on non-cancer skin diseases are rarely investigated.
OBJECTIVE: The aim of the study was to investigate immune-mediated (urticaria, allergic contact dermatitis, and psoriasis) and androgen-mediated (acanthosis nigricans, hidradenitis suppurativa, and acne) skin diseases associated with metformin use.
METHODS: Metformin initiators (n = 234,585) and non-metformin initiators (n = 125,921) within the initial 12 months of antidiabetic drug prescription during 1999-2009 were followed up until December 31, 2011. Cox regression weighted for propensity score was used to estimate hazard ratios for metformin initiators versus non-metformin initiators in intention-to-treat (ITT) and per-protocol (PP) analyses.
RESULTS: For immune-mediated skin diseases, hazard ratios were 0.930 (95% confidence interval: 0.920-0.940) and 0.930 (0.918-0.943) in ITT and PP analyses, respectively, and the hazard ratios for each specific outcome were all significantly below unity. For androgen-mediated skin diseases, the ITT and PP hazard ratios were 1.110 (1.060-1.162) and 0.990 (0.935-1.048), respectively, and all hazard ratios were not significant for each specific outcome except for acne in the ITT analysis (hazard ratio: 1.116, 95% confidence interval: 1.064-1.170).
CONCLUSION: Metformin use is associated with a significantly lower risk of immune-mediated skin diseases but lacks a preventive effect on androgen-mediated skin diseases.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 234,585 participants or records.
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