Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients: A retrospective cohort study
Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients: A retrospective cohort study
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DOI：
10.1002/pds.4560
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发表时间：
2018-08-01
影响因子：
2.6
通讯作者：
Babazono, Akira
中科院分区：
文献类型：
--
作者：
Imatoh, Takuya;Nishi, Takumi;Babazono, Akira
目的二肽基肽酶-4(DPP-4)抑制剂是一类新型抗糖尿病药物。尽管它们被报道会增加感染的风险，但这一发现是有争议的。鉴于尿路感染在老年人中很常见，我们利用医疗保险索赔数据进行了一项回顾性队列研究，以阐明DPP-4抑制剂与晚期老年患者尿路感染发生率的关系。方法我们分析了2011至2016财年75岁及以上的日本患者25,111例。使用DPP-4抑制剂和磺脲类药物(SU)的患者通过倾向评分以1：1的比例匹配。Poisson回归分析比较SU组和DPP-4抑制剂组的尿路感染发生率比(IRR)。结果使用DPP-4抑制剂可增加男性患者发生尿路感染的风险(调整后的IRR为1.23，95%CI为1.04~1.45)。在倾向评分匹配后，相关性仍然显著(调整后的IRR为1.28，95%CI[1.05-1.56])。此外，接受DPP-4抑制剂治疗的老年男性前列腺增生症患者发生尿路感染的风险高于非前列腺增生症患者(匹配：原始IRR 2.90，95%CI[1.78~4.71]；调整后IRR 2.32，95%CI[1.40~3.84])。结论老年患者，尤其是男性前列腺增生症患者长期使用DPP-4抑制剂可能增加UTI的风险。
PurposeDipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of antidiabetic drugs. Although they have been reported to increase the risk of infection, the findings are controversial. Given that urinary tract infections (UTIs) are common in the elderly, we conducted a retrospective cohort study by using health care insurance claims data, to elucidate the association between the DPP-4 inhibitors and the incidence of UTI in latter-stage elderly patients.MethodsWe analyzed 25,111 Japanese patients aged 75years and older between the fiscal years 2011 and 2016. Patients using DPP-4 inhibitors and sulfonylureas (SUs) were matched at a 1:1 ratio using propensity scoring. The Incidence rate ratio (IRR) of UTI was compared between users of SUs and users of DPP-4 inhibitors by Poisson regression. Moreover, subgroup analyses stratified by sex were conducted to evaluate whether the combination of prostatic hyperplasia and DPP-4 inhibitors is associated with the incidence of UTI in male patients.ResultsThe use of DPP-4 inhibitors was associated with an increased risk of UTI (adjusted IRR 1.23, 95% CI [1.04-1.45]). After propensity score matching, the association remained significant (adjusted IRR 1.28, 95% CI [1.05-1.56]). Moreover, elderly male patients with prostatic hyperplasia who received DPP-4 inhibitors had a higher risk of UTI than SU users without prostatic hyperplasia (Matched: crude IRR 2.90, 95% CI [1.78-4.71]; adjusted IRR 2.32, 95% CI [1.40-3.84]).ConclusionsThe long-term use of DPP-4 inhibitors by elderly patients, particularly male patients with prostatic hyperplasia, may increase the risk of UTI.