Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Clin Gastroenterol Hepatol. 2024 Jun;22(6):1226-1237.e14. doi: 10.1016/j.cgh.2023.08.034. Epub 2023 Sep 15.
BACKGROUND & AIMS: Concerns have been raised that the incretin-based diabetes drugs dipeptidyl peptidase 4 (DPP4) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists may increase the risk of intestinal obstruction. We aimed to assess the association between use of DPP4 inhibitors and GLP-1 receptor agonists and the risk of intestinal obstruction.
Using data from nationwide registers in Sweden, Denmark, and Norway, 2013-2021, we conducted 2 cohort studies, one for DPP4 inhibitors and one for GLP-1 receptor agonists, to investigate the risk of intestinal obstruction as compared with an active comparator drug class (sodium-glucose co-transporter 2 [SGLT2] inhibitors).
Among 19,0321 new users of DPP4 inhibitors (median (interquartile range [IQR]) follow-up time, 1.3 [0.6-2.6] years) and 139,315 new users of SGLT2 inhibitors (median [IQR] follow-up time, 0.8 [0.4-1.7] years), 919 intestinal obstruction events occurred. Use of DPP4 inhibitors, as compared with SGLT2 inhibitors, was not associated with a statistically significant increase in risk of intestinal obstruction (adjusted incidence rate, 2.0 vs 1.8 per 1000 person-years; hazard ratio, 1.13; 95% confidence interval, 0.96-1.34). Among 121,254 new users of GLP-1 receptor agonists (median [standard deviation] follow-up time, 0.9 [0.4-1.9] years) and 185,027 new users of SGLT2 inhibitors (median [IQR] follow-up time, 0.8 [0.4-1.8] years), 557 intestinal obstruction events occurred. Use of GLP-1 receptor agonists was not associated with a statistically significant increase in risk of intestinal obstruction (adjusted incidence rate, 1.3 vs 1.6 per 1000 person-years; hazard ratio, 0.83; 95% confidence interval, 0.69-1.01).
In this analysis of nationwide data from 3 countries, previous safety signals indicating an increased risk of intestinal obstruction with use of DPP4 inhibitors and GLP-1 receptor agonists were not confirmed.
人们担心基于肠促胰岛素的糖尿病药物二肽基肽酶 4（DPP4）抑制剂和胰高血糖素样肽 1（GLP-1）受体激动剂可能会增加肠梗阻的风险。我们旨在评估 DPP4 抑制剂和 GLP-1 受体激动剂的使用与肠梗阻风险之间的关联。
我们使用来自瑞典、丹麦和挪威的全国性登记处的数据，在 2013 年至 2021 年期间进行了两项队列研究，一项针对 DPP4 抑制剂，一项针对 GLP-1 受体激动剂，以比较与活性对照药物类别（钠-葡萄糖共转运蛋白 2 [SGLT2] 抑制剂）相比，评估肠梗阻的风险。
在 190321 例新使用 DPP4 抑制剂（中位[四分位距（IQR）]随访时间 1.3[0.6-2.6]年）和 139315 例新使用 SGLT2 抑制剂（中位[IQR]随访时间 0.8[0.4-1.7]年）的患者中，发生了 919 例肠梗阻事件。与 SGLT2 抑制剂相比，DPP4 抑制剂的使用与肠梗阻风险的统计学显著增加无关（调整后的发病率，每 1000 人年 2.0 与 1.8；危险比，1.13；95%置信区间，0.96-1.34）。在 121254 例新使用 GLP-1 受体激动剂（中位[标准差]随访时间 0.9[0.4-1.9]年）和 185027 例新使用 SGLT2 抑制剂（中位[IQR]随访时间 0.8[0.4-1.8]年）的患者中，发生了 557 例肠梗阻事件。使用 GLP-1 受体激动剂与肠梗阻风险的统计学显著增加无关（调整后的发病率，每 1000 人年 1.3 与 1.6；危险比，0.83；95%置信区间，0.69-1.01）。
在这项来自 3 个国家的全国性数据分析中，先前的安全性信号表明 DPP4 抑制剂和 GLP-1 受体激动剂的使用会增加肠梗阻的风险，但没有得到证实。
