Département d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Centre de Recherche des Cordeliers, INSERM, Paris, France.
Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, INSERM, INRA, C2VN, Aix-Marseille University, Marseille, France.
Diabetes Obes Metab. 2021 May;23(5):1162-1172. doi: 10.1111/dom.14324. Epub 2021 Feb 16.
To investigate the association between routine use of dipeptidyl peptidase-4 (DPP-4) inhibitors and the severity of coronavirus disease 2019 (COVID-19) infection in patient with type 2 diabetes in a large multicentric study.
This study was a secondary analysis of the CORONADO study on 2449 patients with type 2 diabetes (T2D) hospitalized for COVID-19 in 68 French centres. The composite primary endpoint combined tracheal intubation for mechanical ventilation and death within 7 days of admission. Stabilized weights were computed for patients based on propensity score (DPP-4 inhibitors users vs. non-users) and were used in multivariable logistic regression models to estimate the average treatment effect in the treated as inverse probability of treatment weighting (IPTW).
Five hundred and ninety-six participants were under DPP-4 inhibitors before admission to hospital (24.3%). The primary outcome occurred at similar rates in users and non-users of DPP-4 inhibitors (27.7% vs. 28.6%; p = .68). In propensity analysis, the IPTW-adjusted models showed no significant association between the use of DPP-4 inhibitors and the primary outcome by Day 7 (OR [95% CI]: 0.95 [0.77-1.17]) or Day 28 (OR [95% CI]: 0.96 [0.78-1.17]). Similar neutral findings were found between use of DPP-4 inhibitors and the risk of tracheal intubation and death.
These data support the safety of DPP-4 inhibitors for diabetes management during the COVID-19 pandemic and they should not be discontinued.
在一项大型多中心研究中，调查 2 型糖尿病患者常规使用二肽基肽酶-4（DPP-4）抑制剂与 2019 年冠状病毒病（COVID-19）感染严重程度之间的关系。
本研究是对 68 家法国中心 2449 例 2 型糖尿病（T2D）COVID-19 住院患者的 CORONADO 研究的二次分析。主要复合终点是入院后 7 天内气管插管进行机械通气和死亡。根据倾向评分（DPP-4 抑制剂使用者与非使用者）为患者计算稳定权重，并在多变量逻辑回归模型中使用，以估计治疗组中平均治疗效果作为逆概率治疗加权（IPTW）。
596 名患者在入院前使用 DPP-4 抑制剂（24.3%）。使用者和非使用者的主要结局发生率相似（27.7% vs. 28.6%；p =.68）。在倾向分析中，IPTW 调整模型显示，DPP-4 抑制剂的使用与第 7 天的主要结局（OR [95%CI]：0.95 [0.77-1.17]）或第 28 天（OR [95%CI]：0.96 [0.78-1.17]）无显著相关性。在使用 DPP-4 抑制剂与气管插管和死亡风险之间也发现了类似的中性发现。
这些数据支持 COVID-19 大流行期间使用 DPP-4 抑制剂管理糖尿病的安全性，不应停用。
