The Prospect of Rheumatoid Arthritis Prevention

Zhao et al.: We intend to conduct large-scale, multi-center, longitudinal, real-world, cohort studies with extended follow-up periods to assess the longterm effects of TZD use on RA incidence and other relevant outcomes in Ningbo City and other cities. We may conduct the RCT DUPLICATE (Randomized, Controlled Trials Duplicated Using Prospective Longitudinal Insurance Claims: Applying Techniques of Epidemiology) Initiative, which can simulate randomized clinical trials of TZD and other disease-modifying anti-rheumatic drugs using non-randomized real-world evidence studies.

TR: What sort of data would be required to support the use of TZDs as preventative therapy for RA?

Zhao et al.: To support the use of TZDs as preventive therapy for RA, comprehensive data from [randomized controlled trials] or large-scale observational studies [are] essential. These studies should ideally include long-term follow-up data, diverse patient populations, comparative effectiveness and so on.

TR: How would you go about studying this in parts of the world where TZDs aren’t as commonly used for the treatment of diabetes as they are in China (e.g., the U.S.)?

Zhao et al.: We hope to establish collaborations with international research networks, academic institutions and healthcare organizations to access diverse patient populations across different regions. Collaborative efforts facilitate data sharing, harmonization of methodologies, and recruitment of larger sample sizes, enhancing the statistical power and generalizability of study findings.

TR: Are there any other major takeaways that you want to stress to readers?

Zhao et al.: The potential repurposing of TZDs, which are commonly used for diabetes management, as preventive agents for RA underscores the importance of exploring drug repositioning and the multifaceted effects of existing medications.

Conclusion

In summary, Zhao et al. revealed a fascinating association between TZD use and a decreased incidence of RA. Larger studies are needed to confirm causality before the routine use of TZDs for RA prevention can be routinely recommended, but the prospect is certainly exciting.

Samantha C. Shapiro, MD, is the executive editor of Harrison’s Principles of Internal Medicine. As a clinician educator, she practices telerheumatology and writes for both medical and lay audiences.

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