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.

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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