| アブストラクト | OBJECTIVE: To assess whether the use of dipeptidyl peptidase-4 inhibitors is associated with the incidence of inflammatory bowel disease in patients with type 2 diabetes. DESIGN: Population based cohort study. SETTING: More than 700 general practices contributing data to the United Kingdom Clinical Practice Research Datalink. PARTICIPANTS: A cohort of 141 170 patients, at least 18 years of age, starting antidiabetic drugs between 1 January 2007 and 31 December 2016, with follow-up until 30 June 2017. MAIN OUTCOME MEASURES: Adjusted hazard ratios for incident inflammatory bowel disease associated with use of dipeptidyl peptidase-4 inhibitors overall, by cumulative duration of use, and by time since initiation, estimated using time dependent Cox proportional hazards models. Use of dipeptidyl peptidase-4 inhibitors was modelled as a time varying variable and compared with use of other antidiabetic drugs, with exposures lagged by six months to account for latency and diagnostic delays. RESULTS: During 552 413 person years of follow-up, 208 incident inflammatory bowel disease events occurred (crude incidence rate of 37.7 (95% confidence interval 32.7 to 43.1) per 100 000 person years). Overall, use of dipeptidyl peptidase-4 inhibitors was associated with an increased risk of inflammatory bowel disease (53.4 v 34.5 per 100 000 person years; hazard ratio 1.75, 95% confidence interval 1.22 to 2.49). Hazard ratios gradually increased with longer durations of use, reaching a peak after three to four years of use (hazard ratio 2.90, 1.31 to 6.41) and decreasing after more than four years of use (1.45, 0.44 to 4.76). A similar pattern was observed with time since starting dipeptidyl peptidase-4 inhibitors. These findings remained consistent in several sensitivity analyses. CONCLUSIONS: In this first population based study, the use of dipeptidyl peptidase-4 inhibitors was associated with an increased risk of inflammatory bowel disease. Although these findings need to be replicated, physicians should be aware of this possible association. |
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| 投稿者 | Abrahami, Devin; Douros, Antonios; Yin, Hui; Yu, Oriana Hoi Yun; Renoux, Christel; Bitton, Alain; Azoulay, Laurent |
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| 組織名 | Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, QC, Canada H3T 1E2.;Department of Epidemiology, Biostatistics, and Occupational Health, McGill;University, Montreal, QC, Canada.;Institute of Clinical Pharmacology and Toxicology, Charite - Universitatsmedizin;Berlin, Berlin, Germany.;Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada.;Department of Neurology and Neurosurgery, McGill University, Montreal, QC,;Canada.;Division of Gastroenterology, Department of Medicine, McGill University,;Montreal, QC, Canada.;McGill University Health Centre, Montreal, QC, Canada.;Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada. |
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