Umetsu Ryogo, Nishibata Yuri, Abe Junko, Suzuki Yukiya, Hara Hideaki, Nagasawa Hideko, Kinosada Yasutomi, Nakamura Mitsuhiro
Drug Informatics, Gifu Pharmaceutical University.
Yakugaku Zasshi. 2014;134(2):299-304. doi: 10.1248/yakushi.13-00225.
Hypoglycemia due to treatment with oral anti-hyperglycemic agents (OHAs) is a major clinical problem in patients with type 2 diabetes mellitus. The aim of the present study was to evaluate the risk of hypoglycemia due to OHA use by using the Japanese Adverse Drug Event Report (JADER) database. To this end, reports of hypoglycemia events included in the JADER database between 2004 and 2012 were analyzed by calculating the reporting odds ratio (OR). The Medical Dictionary for Regulatory Activities Preferred Terms was used to identify hypoglycemia; 254392 reports were found in the JADER database, of which 13269 were excluded because the age and sex of the patient were not reported. Finally, 241123 reports were analyzed. Among OHAs, sulfonylureas showed the highest adjusted OR (adjusted OR, 10.13; 95% confidence interval, 9.08-11.26). The adjusted ORs for meglitinides, biguanide, thiazolidinedione, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors were significantly lower than that of sulfonylureas. The adjusted OR of meglitinides (3.17; 95% confidence interval, 2.23-4.36) was significantly higher than that of alpha-glucosidase inhibitors or thiazolidinedione. We observed no difference between the adjusted ORs for biguanide, thiazolidinedione, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors. Data mining of the JADER database was useful for analyzing OHA-associated hypoglycemia events. The results of our study suggested a low risk of hypoglycemia associated with biguanide, thiazolidinedione, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors in clinical practice.
口服降糖药(OHA)治疗所致低血糖是2型糖尿病患者的一个主要临床问题。本研究的目的是利用日本药品不良事件报告(JADER)数据库评估使用OHA导致低血糖的风险。为此,通过计算报告比值比(OR)对JADER数据库中2004年至2012年期间纳入的低血糖事件报告进行了分析。使用《监管活动医学词典优选术语》来识别低血糖;在JADER数据库中发现了254392份报告,其中13269份因未报告患者的年龄和性别而被排除。最终,对241123份报告进行了分析。在OHA中,磺脲类药物的校正OR最高(校正OR,10.13;95%置信区间,9.08 - 11.26)。瑞格列奈类、双胍类、噻唑烷二酮类、α-葡萄糖苷酶抑制剂和二肽基肽酶-4抑制剂的校正OR显著低于磺脲类药物。瑞格列奈类药物的校正OR(3.17;95%置信区间,2.23 - 4.36)显著高于α-葡萄糖苷酶抑制剂或噻唑烷二酮类。我们观察到双胍类、噻唑烷二酮类、α-葡萄糖苷酶抑制剂和二肽基肽酶-4抑制剂的校正OR之间没有差异。对JADER数据库进行数据挖掘有助于分析与OHA相关的低血糖事件。我们的研究结果表明,在临床实践中,双胍类、噻唑烷二酮类、α-葡萄糖苷酶抑制剂和二肽基肽酶-4抑制剂导致低血糖的风险较低。