Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Diabetes Care. 2019 Nov;42(11):2065-2074. doi: 10.2337/dc19-0162. Epub 2019 Aug 30.
A recent study raises concerns that dipeptidyl peptidase 4 inhibitors (DPP4i) are associated with increased risk of inflammatory bowel disease (IBD). We evaluated the association between new use of DPP4i and IBD risk compared with other second-line antihyperglycemics.
We implemented an active-comparator, new-user cohort design using two U.S. administrative claims databases for commercially insured (MarketScan) and older adult (Medicare fee-for-service, 20% random sample) patients from January 2007 to December 2016. We identified patients, aged ≥18 years, who initiated DPP4i versus sulfonylureas (SUs) or initiated DPP4i versus thiazolidinediones (TZDs) and were without prior diagnosis, treatment, or procedure for IBD. The primary outcome was incident IBD, defined by IBD diagnosis preceded by colonoscopy and biopsy and followed by IBD treatment. We performed propensity score weighting to control for measured baseline confounding, estimated adjusted hazard ratios (aHRs [95% CI]) using weighted Cox proportional hazards models, and used random-effects meta-analysis models to pool aHRs across cohorts.
We identified 895,747 eligible patients initiating DPP4i, SU, or TZD; IBD incidence rates ranged from 11.6 to 32.3/100,000 person-years. Over a median treatment duration of 1.09-1.69 years, DPP4i were not associated with increased IBD risk across comparisons. The pooled aHRs for IBD were 0.82 (95% CI 0.41-1.61) when comparing DPP4i ( = 161,612) to SU ( = 310,550) and 0.76 (0.46-1.26) when comparing DPP4i ( = 205,570) to TZD ( = 87,543).
Our population-based cohort study of U.S. adults with diabetes suggests that short-term DPP4i treatment does not increase IBD risk.
最近的一项研究表明，二肽基肽酶 4 抑制剂（DPP4i）与炎症性肠病（IBD）风险增加有关。我们评估了与其他二线降糖药相比，新使用 DPP4i 与 IBD 风险之间的关联。
我们使用两个美国行政索赔数据库（市场扫描）和老年人群（医疗保险按服务收费，20%随机样本），实施了一项活性对照、新用户队列设计，纳入了 2007 年 1 月至 2016 年 12 月期间年龄≥18 岁的患者，这些患者无 IBD 的既往诊断、治疗或手术史。主要结局是新诊断的 IBD，其定义为 IBD 诊断前进行结肠镜检查和活检，随后进行 IBD 治疗。我们通过倾向评分加权控制了测量的基线混杂因素，使用加权 Cox 比例风险模型估计了调整后的危险比（aHR[95%CI]），并使用随机效应荟萃分析模型对队列之间的 aHR 进行了汇总。
我们确定了 895747 名符合条件的开始使用 DPP4i、SU 或 TZD 的患者；IBD 的发病率范围为 11.6 至 32.3/100,000 人年。在中位数为 1.09-1.69 年的治疗期间，DPP4i 与 IBD 风险增加无关。当将 DPP4i（ = 161612）与 SU（ = 310550）进行比较时，IBD 的汇总 aHR 为 0.82（95%CI 0.41-1.61），当将 DPP4i（ = 205570）与 TZD（ = 87543）进行比较时，IBD 的汇总 aHR 为 0.76（0.46-1.26）。
我们对美国糖尿病患者的基于人群的队列研究表明，短期 DPP4i 治疗不会增加 IBD 风险。
