Short term use of DPP4 Inhibitors not linked to increased IBD risk
After a Canadian trial has found that Dipeptidyl peptidase 4 inhibitors (DPP4i) are associated with increased risk of Inflammatory Bowel Disease in Type 2 diabetes patients, this relatively new class of blood sugar-lowering drug has become a point of concern for its users and clinicians who use to prescribe it. To validate this data, scientists from the University of North Carolina conducted a cohort study which revealed that the risk of IBD is less in Short term DPP4 Inhibitor users in comparison to Thiazolidinediones users.
The authors also noted a slightly decreased pooled hazard ratio (pHRs) in DPP4i as compared to other therapeutic alternatives, especially TZD, suggesting the possibility of a protective effect.
The authors implemented an active-comparator, new-user cohort design using two U.S. administrative claims databases for commercially insured (MarketScan) and older adults (Medicare fee-for-service, 20% random sample) patients from January 2007 to December 2016. They identified patients, aged around 18 years, who initiated DPP4i versus sulfonylureas (SUs) or initiated DPP4i versus thiazolidinediones (TZDs) and without a 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.
Read also: Use of (DPP-4) inhibitors linked to increased risk of IBD : BMJ
The authors 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.
Key findings of the study
- A total of 895,747 patients were identified initiating DPP4i, SU, or TZD; IBD incidence rates ranged from 11.6 to 32.3/100,000 person-years.
- DPP4i was not associated with increased IBD risk across comparisons, over a median treatment duration of 1.09–1.69 years.
- The pooled aHRs for IBD was 0.82 when comparing DPP4i to SU and 0.76 when comparing DPP4i to TZD.
Summing up their findings the authors stated that "Our population-based cohort study of U.S. adults with diabetes suggests that short-term DPP4i treatment does not increase IBD risk."
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https://doi.org/10.2337/dc19-0162
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