The Use Metformin in Lupus: How does this apply to our Discoid LE (DLE) Patients?

Metformin for Lupus: Will it help discoid lupus?

Metformin is a well known diabetes drug. Recent evidence has suggested that metformin may have a positive impact on the treatment of some autoimmune diseases.

Metformin is well understood to reduce glucose production by the liver and to reduce absorption of glucose in the gastrointestinal tract and to increase insulin sensitivity. However, metformin may also reduce production of reactive oxygen species (ROS) which help create inflammation in lupus. The possible benefits of metformin in lupus was demonstrated in 2015 where Wang and colleagues in the journal Arthritis and Rheumatolgy showed that metformin reduce the risk of disease flares by 51 % compared to conventional treatment.

In a 2018 poster by McLeod and colleagues presented at the 2018 meeting of the American College of Rheumatology, authors showed that metformin helps patients with lupus improve control of their disease. The researchers studied 15 patients with lupus using metformin and compared to 1331 patients not using metformin. The authors found there ws a difference in disease activity in patients using metformin.

Metformin for Discoid Lupus: Will it help?

These studies are interesting as they suggest that metformin has the potential to help patients with lupus. What we don’t know yet is whether metformin will help the various types of ‘cutaneous’ lupus including discoid lupus.

Metformin may have an impact not only on autoimmune diseases (including effects on monocytes, macrophages and neutrophils), but improve gut microbiota and have an antifibrotic effect as well. These effects together make them ideal to consider in the study of scarring alopecia. We already know that drugs as pioglitazone may be helpful in lichen planopilaris.

REFERENCES

Wang et al. Neutrophil Extracellular Trap Mitochondrial DNA and Its Autoantibody in Systemic Lupus Erythematosus and a Proof-of-Concept Trial of Metformin.Arthritis Rheumatol. 2015 Dec;67(12):3190-200. doi: 10.1002/art.39296.

McLeod C, Olayemi G, Bhatia N, Migliore F, Quinet R. The Impact of Metformin on Disease Activity in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/the-impact-of-metformin-on-disease-activity-in-systemic-lupus-erythematosus/. ABSTRACT NUMBER: 2645