Department of Pharmacy, Peking University Third Hospital, 49, Huayuan North Road, 100191 Beijing, Haidian District, China.
Department of Pharmacy, Peking University Third Hospital, 49, Huayuan North Road, 100191 Beijing, Haidian District, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China.
Diabetes Metab. 2017 Dec;43(6):493-500. doi: 10.1016/j.diabet.2017.05.013. Epub 2017 Aug 1.
The US Food and Drug Administration has warned that treatment with dipeptidyl peptidase (DPP)-4 inhibitors may promote serious arthralgia. However, the clinical evidence for this is relatively lacking.
For this reason, a systematic review and meta-analysis of randomized controlled trials (RCTs) were carried out to determine the relationship between DPP-4 inhibitors and risk of arthralgia, and also to investigate any potential risk factors.
An extensive electronic search for RCTs comparing DPP-4 inhibitors with any comparators was performed up to July 2016. Outcomes of interest were overall and serious arthralgia. Summary risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.
A total of 67 RCTs (involving 79,110 patients) was ultimately included. Pooled results showed that DPP-4 inhibitors were associated with a slightly but significantly increased risk of overall arthralgia (RR: 1.13, 95% CI: 1.04-1.22; P=0.003) and a non-significant increased risk of serious arthralgia (RR: 1.44, 95% CI: 0.83-2.51; P=0.20). Also, subgroup analyses showed that add-on/combination therapy and longer diabetes duration (>5years) were possible factors associated with the increased risk of overall arthralgia.
These findings suggest that DPP-4 inhibitors can increase the risk of arthralgia. Thus, the benefits of glycaemic control must be weighed against the risk of arthralgia when prescribing DPP-4 inhibitors. Further studies are now needed to identify and confirm these risk factors.
美国食品和药物管理局警告称，使用二肽基肽酶-4（DPP-4）抑制剂治疗可能会导致严重的关节痛。然而，这方面的临床证据相对较少。
因此，进行了一项系统评价和随机对照试验（RCT）的荟萃分析，以确定 DPP-4 抑制剂与关节痛风险之间的关系，并探讨任何潜在的危险因素。
对截至 2016 年 7 月比较 DPP-4 抑制剂与任何对照药物的 RCT 进行了广泛的电子检索。感兴趣的结局是总体和严重关节痛。计算汇总风险比（RR）和 95%置信区间（CI）。
最终纳入了 67 项 RCT（涉及 79110 名患者）。汇总结果显示，DPP-4 抑制剂与总体关节痛的风险略有但显著增加相关（RR：1.13，95%CI：1.04-1.22；P=0.003），且严重关节痛的风险无显著增加（RR：1.44，95%CI：0.83-2.51；P=0.20）。此外，亚组分析表明，附加/联合治疗和更长的糖尿病病程（>5 年）可能是与总体关节痛风险增加相关的因素。
这些发现表明 DPP-4 抑制剂可能会增加关节痛的风险。因此，在开具 DPP-4 抑制剂时，必须权衡血糖控制的益处与关节痛的风险。现在需要进一步的研究来识别和确认这些危险因素。
