Background: Metformin may show an antibiotic effect, but whether its use can reduce the\nrisk of tuberculosis infection has rarely been investigated in population-based studies. Methods:\nThis is a retrospective cohort analysis of the Taiwanâ??s National Health Insurance database. New-onset\ntype 2 diabetes patients, 148,468 ever users and 15,799 never users of metformin, identified during\n1999â??2005 were followed up until 31 December 2011 for the incidence of tuberculosis infection.\nHazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment\nweighting using propensity score. Results: A total of 360 never users and 1976 ever users developed\na tuberculosis infection with respective incidence of 510.91 and 282.94 per 100,000 personâ??years.\nThe overall hazard ratio of presenting a tuberculosis infection among metformin ever users in\nrespect to never users was 0.552 (95% confidence interval: 0.493â??0.617). The hazard ratios for the\nfirst (<27.10 months), second (27.10â??58.27 months), and third (>58.27 months) tertile of cumulative\nduration of metformin therapy were 1.116 (0.989â??1.261), 0.543 (0.478â??0.618), and 0.200 (0.171â??0.233),\nrespectively; and were 1.037 (0.918â??1.173), 0.533 (0.469â??0.606), and 0.249 (0.215â??0.288), respectively,\nfor the first (<817,000 mg), second (817,000â??2,047,180 mg), and third (>2,047,180 mg) tertile of\ncumulative doses of metformin. The findings were consistent when analyses were restricted to\npulmonary tuberculosis. Additionally, regular users of metformin tended to have greater benefit\nthan irregular users. Conclusions: Metformin use is associated with a reduced risk of tuberculosis\ninfection in a doseâ??response pattern in type 2 diabetes patients.
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