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No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase-4 inhibitors vs therapeutic alternatives.
Diabetes Obes Metab. 2017 07; 19(7):970-978.DO

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.

Authors+Show Affiliations

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Real World Evidence, GlaxoSmithKline, Collegeville, Pennsylvania.Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28195389

Citation

Gokhale, Mugdha, et al. "No Increased Risk of Cardiovascular Events in Older Adults Initiating Dipeptidyl Peptidase-4 Inhibitors Vs Therapeutic Alternatives." Diabetes, Obesity & Metabolism, vol. 19, no. 7, 2017, pp. 970-978.
Gokhale M, Buse JB, Jonsson Funk M, et al. No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase-4 inhibitors vs therapeutic alternatives. Diabetes Obes Metab. 2017;19(7):970-978.
Gokhale, M., Buse, J. B., Jonsson Funk, M., Lund, J., Pate, V., Simpson, R. J., & Stürmer, T. (2017). No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase-4 inhibitors vs therapeutic alternatives. Diabetes, Obesity & Metabolism, 19(7), 970-978. https://doi.org/10.1111/dom.12906
Gokhale M, et al. No Increased Risk of Cardiovascular Events in Older Adults Initiating Dipeptidyl Peptidase-4 Inhibitors Vs Therapeutic Alternatives. Diabetes Obes Metab. 2017;19(7):970-978. PubMed PMID: 28195389.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - No increased risk of cardiovascular events in older adults initiating dipeptidyl peptidase-4 inhibitors vs therapeutic alternatives. AU - Gokhale,Mugdha, AU - Buse,John B, AU - Jonsson Funk,Michele, AU - Lund,Jennifer, AU - Pate,Virginia, AU - Simpson,Ross J, AU - Stürmer,Til, Y1 - 2017/03/17/ PY - 2016/10/12/received PY - 2017/02/08/revised PY - 2017/02/08/accepted PY - 2017/2/15/pubmed PY - 2018/5/3/medline PY - 2017/2/15/entrez KW - DPP-4 inhibitor KW - antidiabetic drug KW - database research KW - incretins KW - observational study KW - pharmaco-epidemiology SP - 970 EP - 978 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 19 IS - 7 N2 - 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. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/28195389/No_increased_risk_of_cardiovascular_events_in_older_adults_initiating_dipeptidyl_peptidase_4_inhibitors_vs_therapeutic_alternatives_ L2 - https://doi.org/10.1111/dom.12906 DB - PRIME DP - Unbound Medicine ER -