No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase‐4 inhibitors vs therapeutic alternatives. Issue 7 (17th March 2017)

• Record Type: Journal Article
• Authors: Gokhale, Mugdha; Buse, John B.; Jonsson Funk, Michele; Lund, Jennifer; Pate, Virginia; Simpson, Ross J.; Stürmer, Til
• Is Part Of: Diabetes, obesity & metabolism. Volume 19:Issue 7(2017)
• Page Start: 970
• Page End: 978
• Publication Date: 2017-03-17
• Subjects: antidiabetic drug -- database research -- DPP‐4 inhibitor -- incretins -- observational study -- pharmaco‐epidemiology; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.12906
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract : Aim: To compare the cardiovascular (CV) risk associated with dipeptidyl peptidase‐4 (DPP‐4) inhibitors relative to sulphonylureas (SUs) and thiazolidinediones (TZDs). Methods: During 2007 to 2013, using Medicare data for beneficiaries aged >65 years, we identified the following 2 cohorts of new‐users, who had not been exposed to the drugs being compared in the 6 months before initiation: (1) DPP‐4 inhibitor vs SU initiators and (2) DPP‐4 inhibitor vs TZD initiators. Using propensity‐score‐adjusted Cox models accounting for competing risk by death, we estimated the hazard ratios (HRs), risk differences and 95% confidence intervals (CIs) for myocardial infarction (MI), stroke, hospitalization for heart failure (HF), and a combined outcome (MI, stroke, all‐cause mortality). Results: In the DPP‐4 inhibitor vs SU comparison, there were 30 130 DPP‐4 inhibitor initiators and 68 382 SU initiators. Their mean age was 75 years, 41% were men and 55% had a baseline CV condition. The HR for the composite outcome was 0.75 (95% CI 0.72‐0.79) over a median treatment duration of 1 year, but the 1‐year risks of MI were 1.00 (95% CI 0.89‐1.12) and 1.47 (95% CI 1.38‐1.56) per 100 patients for DPP‐4 inhibitors and SUs, respectively, and the corresponding stroke risks were 0.98 (95% CI 0.87‐1.10) and 1.09 (95% CI 1.01‐1.17). For the DPP‐4 inhibitor vs TZD comparison, there were 20 596 DPP‐4 inhibitor initiators and 13 526 TZD initiators without previous HF. Their mean age was 74 years, 42% were men and 30% had a baseline CV event. The composite outcome HR was 0.94 (95% CI 0.86‐1.02) over a median treatment duration of 1 year. The 1‐year risk for MI was ~0.90 and for stroke it was ~0.80 per 100 patients in both DPP‐4 inhibitor and TZD initiators. Conclusion: Although limited by the short treatment period, the present study suggests there is no increased short‐term risk of MI, stroke or HF with DPP‐4 inhibitors vs SUs/TZDs.