title: Short-term dipeptidyl peptidase-4 inhibitor use increases the risk of herpes zoster infection in Asian patients with diabetes.
abstract: BACKGROUND
  We aimed to evaluate whether patients with diabetes who use dipeptidyl peptidase (DPP)-4 inhibitors are at a higher risk of developing a herpes zoster (HZ) infection.
  
  
  METHODS
  We used a subset of the Longitudinal Health Insurance Database 2000 containing all inpatient and outpatient medical claims of ∼1 million people who were randomly sampled from the National Health Insurance Research Database. Patients who were newly diagnosed with Type 2 diabetes International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM 250.x0 and 250.x2) who used antidiabetic medications were divided into two cohorts based on their use of DPP-4 inhibitors between 2009 and 2011. Cox proportion hazard regression models were used to assess the effects of DPP-4 inhibitors on the incidence of HZ compared with the non-DPP-4-inhibitor-exposed cohort.
  
  
  RESULTS
  Patients in DPP-4-inhibitor-exposed cohort with diabetes and HZ infections revealed an incidence density of 4.20 per 1000 person-years compared with 3.50 per 1000 person-years for the non-DPP-4-inhibitor-exposed cohort (adjusted hazard ratio [HR] = 1.19, 95% confidence interval [CI] = 0.70-1.99). Furthermore, high-dose DPP-4-inhibitor treatment was associated with a significantly higher risk of HZ (adjusted HR = 2.46, 95% CI = 1.16-5.19 for a defined daily dose [DDD] ≥ 360). In addition, short-term DPP-4-inhibitor treatment was associated with a significantly higher risk of HZ (adjusted HR = 2.04, 95% CI = 1.03-4.04 for a DDD ≥ 360 days).
  
  
  CONCLUSIONS
  These results suggest that Asian patients with diabetes who use short-term DPP-4 inhibitors might be at a higher risk of developing HZ.
authors.affiliation: From the Institute of Public Health and Medicine, Chung Shan Medical University, Taichung, Taiwan, Division of Metabolism & Endocrinology, Changhua Christian Hospital, Changhua, Taiwan, Division of Metabolism & Endocrinology, Nantou Christian Hospital, Nantou, Taiwan.
authors.forename: H-H
authors.initials: HH
authors.lastname: Chen
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: C-L
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Metabolism & Endocrinology, Nantou Christian Hospital, Nantou, Taiwan, Department of Healthcare Administration, Asia University, Taichung, Taiwan.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yeh
authors.affiliation: Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan and Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan d10040@mail.cmuh.org.tw.
authors.forename: C-H
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006562:Herpes Zoster / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011897:Random Allocation; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents