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Are DPP-4 Inhibitors Really a Risk Factor for Pneumonia?

An international team of researchers examined a cohort of nearly 50,000 patients to find out….

Dipeptidyl peptidase-4 (DPP-4) inhibitors may alter the immune response and increase the risk of infections, but evidence for this association is limited.

The United Kingdom Clinical Practice Research Datalink (CPRD) and the Hospital Episodes Statistics (HES) database were used to conduct a nested case-control analysis within a cohort of new users of anti-diabetic drugs between 2007 and 2012. Incident cases of hospitalized community-acquired pneumonia were matched with up to 20 controls on age, duration of treated diabetes, calendar year, and duration of follow-up. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalized community-acquired pneumonia associated with current use of DPP-4 inhibitors compared with current use of two or more oral anti-diabetic drugs.

The cohort included 49,653 patients, of whom 562 were hospitalized for community-acquired pneumonia during follow-up (incidence rate: 5.2/1000 person-years). Compared with current use of two or more oral anti-diabetic drugs, current use of DPP-4 inhibitors was not associated with an increased risk of hospitalized community-acquired pneumonia overall (adjusted OR: 0.80, 95% CI: 0.50–1.29) or according to duration of use (p-trend = 0.57).

The use of DPP-4 inhibitors was not associated with an increased risk of hospitalization for community-acquired pneumonia. Additional research is needed to assess the association between these drugs and other serious infections.

Practice Pearls:

  • Very low risk for hospitalization for pneumonia by using DPP-4 inhibitors was seen.
  • DPP-4 inhibitors suppress DNA synthesis of mononucleocytes and T-cells in vitro.
  • Even though DPP-4 inhibitors were not associated with risk of hospital acquired pneumonia, additional research is still needed to identify any risk of other severe infections.

Jean-Luc Faillie. DPP-4 inhibitors and the risk of community-acquired pneumonia in patients with type 2 diabetes. Diabetes, obesity and metabolism 2015; DOI: 10.1111/dom.12431