Incretin‐Based Drugs and Risk of Intestinal Obstruction Among Patients With Type 2 Diabetes

Clinical Pharmacology and Therapeutics - Tập 111 Số 1 - Trang 272-282 - 2022
Jean‐Luc Faillie1,2, Hui Yin3, Oriana Hoi Yun Yu3,4, Astrid Herrero5, Romain Altwegg6, Christel Renoux3,7,8, Laurent Azoulay3,7,9
1Department of Medical Pharmacology and Toxicology, CHU Montpellier University Hospital, Montpellier, France
2UA11 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
3Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
4Division of Endocrinology Jewish General Hospital Montreal Quebec Canada
5Department of Visceral Surgery CHU Montpellier University Hospital Montpellier France
6Department of Gastroenterology CHU Montpellier University Hospital Montpellier France
7Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
8Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
9Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada

Tóm tắt

Glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and dipeptidyl peptidase‐4 (DPP‐4) inhibitors might increase the risk of intestinal obstruction, but real‐world evidence for this severe adverse event is lacking. Thus, the objective of this study was to determine whether GLP‐1 RAs and DPP‐4 inhibitors are associated with an increased risk of intestinal obstruction compared with sodium‐glucose cotransporter‐2 (SGLT‐2) inhibitors. We used the United Kingdom Clinical Practice Research Datalink and linked databases to assemble two new‐user, active comparator cohorts (2013–2019). The first included 25,617 and 67,261 GLP‐1 RA and SGLT‐2 inhibitor users, respectively. The second included 131,927 and 40,615 DPP‐4 inhibitor and SGLT‐2 inhibitor users, respectively. Propensity score fine stratification weighted Cox proportional hazards models were fit to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of intestinal obstruction requiring hospitalization. GLP‐1 RAs were associated with an increased risk of intestinal obstruction compared with SGLT‐2 inhibitors (1.9 vs. 1.1 per 1,000 person‐years, respectively; HR: 1.69, 95% CI: 1.04–2.74). The highest HR was observed after 1.6 years of use (HR: 3.48, 95% CI: 1.79–6.79). DPP‐4 inhibitors were also associated with an increased risk (2.7 vs. 1.0 per 1,000 person‐years; HR: 2.59, 95% CI: 1.52–4.42), with the highest HR observed after 1.8 years of use (HR: 9.53, 95% CI: 4.47–20.30). The number needed to harm after 1 year of use was 1,223 and 603 for GLP‐1 RAs and DPP‐4 inhibitors, respectively. In this large real‐world study, GLP‐1 RAs and DPP‐4 inhibitors were associated with an increased risk of intestinal obstruction.

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Tài liệu tham khảo

10.1056/NEJMoa1603827

10.1056/NEJMoa1607141

10.1056/NEJMoa1612917

10.1016/S0140-6736(19)31149-3

10.1056/NEJMoa1307684

10.1056/NEJMoa1305889

10.1056/NEJMoa1501352

10.1001/jama.2018.18269

10.1016/j.cmet.2006.01.004

10.1155/2011/279530

European Medicine Agency. Pharmacovigilance Risk Assessment Committee (PRAC).Minutes of the meeting –January 7‐10 2013<https://www.ema.europa.eu/en/documents/minutes/minutes‐prac‐meeting‐7‐10‐january‐2013_.pdf>. Accessed July 7 2020.

European Medicine Agency.Pharmacovigilance Risk Assessment Committee (PRAC). Minutes of the meeting –April 7‐10 2015<https://www.ema.europa.eu/en/documents/minutes/minutes‐prac‐meeting‐7‐10‐april‐2015_en.pdf>. Accessed July 7 2020.

10.1111/jdi.12095

Yoshida S., 2014, ‐191: Study on six cases of intestinal obstruction during therapy with DDP‐4 inhibitors, J. Jpn. Diabetes Soc., 57, 311

10.1007/s11894-017-0566-9

10.3748/wjg.v13.i3.432

10.1007/s13340-016-0261-3

10.1016/j.therap.2020.02.024

10.1093/ije/dyv098

10.1592/phco.23.5.686.32205

10.1093/pubmed/21.3.299

Hospital Episode Statistics (HES) National Health Services<https://digital.nhs.uk/data‐and‐information/data‐tools‐and‐services/data‐services/hospital‐episode‐statistics>.

Office for National Statistics<https://www.ons.gov.uk/aboutus/whatwedo>.

CPRD linked data<https://cprd.com/linked‐data>.

10.1136/bmjopen-2017-020827

Gallagher A.M., 2011, 528. Linkage of the General Practice Research Database (GPRD) with other data sources, Pharmacoepidemiol. Drug Saf., 20, 230

10.1007/s00125-019-05039-w

Yamada T., 1998, Handbook of Gastroenterology

Yeh D.D., 2021, UpToDate

Bordeianou L., 2021, UpToDate

10.1097/EDE.0000000000000595

10.1016/j.jclinepi.2011.04.009

10.1002/(SICI)1097-0258(19961215)15:23<2589::AID-SIM373>3.0.CO;2-O

10.1111/j.1365-2982.2007.01079.x

10.1152/ajpgi.2000.278.6.G924

10.1136/gut.2004.059741

10.1016/j.diabet.2017.05.009

10.2337/diab.45.6.832

10.1172/JCI942

10.1111/j.1365-2982.2010.01476.x

10.1185/03007990802418851

10.1210/er.2014-1035

10.1136/gut.28.2.166

10.1073/pnas.79.14.4471

10.1146/annurev-physiol-021113-170317

10.1016/S0167-0115(02)00095-2

10.1152/ajpgi.00282.2010

10.1093/aje/kwg231

10.1136/bmjopen-2015-010210

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Clinical Pharmacology and Therapeutics

Tập 111 Số 1

272-282

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