Knapen Lotte M, de Jong Roy G P J, Driessen Johanna H M, Keulemans Yolande C, van Erp Nielka P, De Bruin Marie L, Leufkens Hubert G M, Croes Sander, de Vries Frank
Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands.
CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Diabetes Obes Metab. 2017 Mar;19(3):401-411. doi: 10.1111/dom.12833. Epub 2017 Feb 7.
AIM: To determine the association between the use of incretin agents (dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists) for the treatment of type 2 diabetes mellitus (T2DM) and the risk of any, acute and chronic pancreatitis. RESEARCH DESIGN AND METHODS: A population-based cohort study was conducted using data from the UK Clinical Practice Research Datalink (CPRD 2007-2012). A total of 182 428 adult patients with ≥1 non-insulin antidiabetic drug (NIAD) prescription were matched to control subjects without diabetes. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of pancreatitis in incretin-users (N = 28 370) compared with controls and with other NIAD users. Adjustments were made for lifestyle, disease and drug history. In a sensitivity analysis, a new-user design was used. RESULTS: Current incretin users had a 1.5-fold increased risk of any pancreatitis compared with NIAD users (adjusted HR 1.47, 95% CI 1.06-2.04). In incident current incretin users the risk of any and acute pancreatitis was increased 2.1- and 2.0-fold compared with NIAD users (adjusted HR 2.12, 95% CI 1.31-3.43 and adjusted HR 1.96, 95% CI 1.13-3.41), whereas there was no increased risk found for chronic pancreatitis. CONCLUSIONS: Incretin use was associated with an increased risk of any pancreatitis. Moreover, risk of any and acute pancreatitis was higher when applying a new-user design. We were not able to detect an association with chronic pancreatitis, but the number in this subgroup was small.
目的:确定使用肠促胰岛素类药物(二肽基肽酶-4抑制剂和胰高血糖素样肽-1受体激动剂)治疗2型糖尿病(T2DM)与任何类型、急性和慢性胰腺炎风险之间的关联。 研究设计与方法:利用英国临床实践研究数据链(CPRD 2007 - 2012年)的数据进行了一项基于人群的队列研究。共有182428名开具过≥1种非胰岛素抗糖尿病药物(NIAD)处方的成年患者与无糖尿病的对照者进行匹配。采用Cox回归分析来估计与对照组及其他NIAD使用者相比,肠促胰岛素使用者(N = 28370)发生胰腺炎的校正风险比(HRs)和95%置信区间(CIs)。对生活方式、疾病和用药史进行了校正。在一项敏感性分析中,采用了新使用者设计。 结果:与NIAD使用者相比,当前使用肠促胰岛素的患者发生任何类型胰腺炎的风险增加了1.5倍(校正HR 1.47,95% CI 1.06 - 2.04)。在新使用肠促胰岛素的患者中,与NIAD使用者相比,发生任何类型和急性胰腺炎的风险分别增加了2.1倍和2.0倍(校正HR 2.12,95% CI 1.31 - 3.43和校正HR 1.96,95% CI 1.13 - 3.41),而慢性胰腺炎风险未见增加。 结论:使用肠促胰岛素与任何类型胰腺炎风险增加有关。此外,采用新使用者设计时,任何类型和急性胰腺炎的风险更高。我们未能检测到与慢性胰腺炎的关联,但该亚组中的病例数较少。
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