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Differential cardiovascular outcomes after dipeptidyl peptidase-4 inhibitor, sulfonylurea, and pioglitazone therapy, all in combination with metformin, for type 2 diabetes: a population-based cohort study.
PLoS One. 2015; 10(5):e0124287.Plos

Abstract

BACKGROUND/OBJECTIVES

Data on the comparative effectiveness of oral antidiabetics on cardiovascular outcomes in a clinical practice setting are limited. This study sought to determine whether a differential risk of cardiovascular disease (CVD) exists for the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor plus metformin versus a sulfonylurea derivative plus metformin or pioglitazone plus metformin.

METHODS

We conducted a cohort study of 349,476 patients who received treatment with a DPP-4 inhibitor, sulfonylurea, or pioglitazone plus metformin for type 2 diabetes using the Korean national health insurance claims database. The incidence of total CVD and individual outcomes of myocardial infarction (MI), heart failure (HF), and ischemic stroke (IS) were assessed using the hazard ratios (HRs) estimated from a Cox proportional-hazards model weighted for a propensity score.

RESULTS

During follow-up, 3,881 patients developed a CVD, including 428 MIs, 212 HFs, and 1,487 ISs. The adjusted HR with 95% confidence interval (CI) for a sulfonylurea derivative plus metformin compared with a DPP-4 inhibitor plus metformin was 1.20 (1.09-1.32) for total CVD; 1.14 (1.04-1.91) for MI; 1.07 (0.71-1.62) for HF; and 1.51 (1.28-1.79) for IS. The HRs with 95% CI for total CVD, MI, HF, and IS for pioglitazone plus metformin were 0.89 (0.81-0.99), 1.05 (0.76-1.46), 4.81 (3.53-6.56), and 0.81 (0.67-0.99), respectively.

CONCLUSIONS

Compared with a DPP-4 inhibitor plus metformin, treatment with a sulfonylurea drug plus metformin was associated with increased risks of total CVD, MI, and IS, whereas the use of pioglitazone plus metformin was associated with decreased total CVD and IS risks.

Authors+Show Affiliations

Office of Drug Safety Information II, Korea Institute of Drug Safety & Risk Management, Seoul, Republic of Korea; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea; Medical Research Center, Seoul National University, Seoul, Republic of Korea.Office of Drug Utilization Review, Korea Institute of Drug Safety & Risk Management, Seoul, Republic of Korea.Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.Office of Drug Safety Information I, Korea Institute of Drug Safety & Risk Management, Seoul, Republic of Korea.Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea.Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea.Office of Drug Safety Information II, Korea Institute of Drug Safety & Risk Management, Seoul, Republic of Korea; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Office of Drug Utilization Review, Korea Institute of Drug Safety & Risk Management, Seoul, Republic of Korea; Office of Drug Safety Information I, Korea Institute of Drug Safety & Risk Management, Seoul, Republic of Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25992614

Citation

Seong, Jong-Mi, et al. "Differential Cardiovascular Outcomes After Dipeptidyl Peptidase-4 Inhibitor, Sulfonylurea, and Pioglitazone Therapy, All in Combination With Metformin, for Type 2 Diabetes: a Population-based Cohort Study." PloS One, vol. 10, no. 5, 2015, pp. e0124287.
Seong JM, Choi NK, Shin JY, et al. Differential cardiovascular outcomes after dipeptidyl peptidase-4 inhibitor, sulfonylurea, and pioglitazone therapy, all in combination with metformin, for type 2 diabetes: a population-based cohort study. PLoS One. 2015;10(5):e0124287.
Seong, J. M., Choi, N. K., Shin, J. Y., Chang, Y., Kim, Y. J., Lee, J., Kim, J. Y., & Park, B. J. (2015). Differential cardiovascular outcomes after dipeptidyl peptidase-4 inhibitor, sulfonylurea, and pioglitazone therapy, all in combination with metformin, for type 2 diabetes: a population-based cohort study. PloS One, 10(5), e0124287. https://doi.org/10.1371/journal.pone.0124287
Seong JM, et al. Differential Cardiovascular Outcomes After Dipeptidyl Peptidase-4 Inhibitor, Sulfonylurea, and Pioglitazone Therapy, All in Combination With Metformin, for Type 2 Diabetes: a Population-based Cohort Study. PLoS One. 2015;10(5):e0124287. PubMed PMID: 25992614.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential cardiovascular outcomes after dipeptidyl peptidase-4 inhibitor, sulfonylurea, and pioglitazone therapy, all in combination with metformin, for type 2 diabetes: a population-based cohort study. AU - Seong,Jong-Mi, AU - Choi,Nam-Kyong, AU - Shin,Ju-Young, AU - Chang,Yoosoo, AU - Kim,Ye-Jee, AU - Lee,Joongyub, AU - Kim,Ju-Young, AU - Park,Byung-Joo, Y1 - 2015/05/20/ PY - 2014/08/14/received PY - 2015/03/12/accepted PY - 2015/5/21/entrez PY - 2015/5/21/pubmed PY - 2016/2/19/medline SP - e0124287 EP - e0124287 JF - PloS one JO - PLoS One VL - 10 IS - 5 N2 - BACKGROUND/OBJECTIVES: Data on the comparative effectiveness of oral antidiabetics on cardiovascular outcomes in a clinical practice setting are limited. This study sought to determine whether a differential risk of cardiovascular disease (CVD) exists for the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor plus metformin versus a sulfonylurea derivative plus metformin or pioglitazone plus metformin. METHODS: We conducted a cohort study of 349,476 patients who received treatment with a DPP-4 inhibitor, sulfonylurea, or pioglitazone plus metformin for type 2 diabetes using the Korean national health insurance claims database. The incidence of total CVD and individual outcomes of myocardial infarction (MI), heart failure (HF), and ischemic stroke (IS) were assessed using the hazard ratios (HRs) estimated from a Cox proportional-hazards model weighted for a propensity score. RESULTS: During follow-up, 3,881 patients developed a CVD, including 428 MIs, 212 HFs, and 1,487 ISs. The adjusted HR with 95% confidence interval (CI) for a sulfonylurea derivative plus metformin compared with a DPP-4 inhibitor plus metformin was 1.20 (1.09-1.32) for total CVD; 1.14 (1.04-1.91) for MI; 1.07 (0.71-1.62) for HF; and 1.51 (1.28-1.79) for IS. The HRs with 95% CI for total CVD, MI, HF, and IS for pioglitazone plus metformin were 0.89 (0.81-0.99), 1.05 (0.76-1.46), 4.81 (3.53-6.56), and 0.81 (0.67-0.99), respectively. CONCLUSIONS: Compared with a DPP-4 inhibitor plus metformin, treatment with a sulfonylurea drug plus metformin was associated with increased risks of total CVD, MI, and IS, whereas the use of pioglitazone plus metformin was associated with decreased total CVD and IS risks. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25992614/Differential_cardiovascular_outcomes_after_dipeptidyl_peptidase_4_inhibitor_sulfonylurea_and_pioglitazone_therapy_all_in_combination_with_metformin_for_type_2_diabetes:_a_population_based_cohort_study_ L2 - https://dx.plos.org/10.1371/journal.pone.0124287 DB - PRIME DP - Unbound Medicine ER -