title: Dipeptidyl Peptidase-4 Inhibitor Use Is Not Associated With Acute Pancreatitis in High-Risk Type 2 Diabetic Patients: A Nationwide Cohort Study.
abstract: To analyze the association between use of DPP-4 inhibitors and acute pancreatitis in high-risk type 2 diabetic patients. A retrospective nationwide cohort study was conducted using the Taiwan National Health Insurance claim database. The risk associated with sitagliptin was compared to that with acarbose, a second-line antidiabetic drug prescribed for patients with similar diabetes severity and with a known neutral effect on pancreatitis. Between January 1, 2009 and December 31, 2010, a total of 8526 sitagliptin initiators and 8055 acarbose initiators who had hypertriglyceridemia or prior hospitalization history for acute pancreatitis were analyzed for the risk of hospitalization due to acute pancreatitis stratified for baseline propensity score. In the crude analysis, sitagliptin was associated with a decreased risk of acute pancreatitis (hazard ratio [HR] 0.74; 95% confidence interval [CI]: 0.62-0.88) compared to acarbose in diabetic patients with prior history of hospitalization for pancreatitis or hypertriglyceridemia. The association was abolished after stratification for propensity score quintiles (adjusted HR 0.95; 95% CI: 0.79-1.16). Similar results were found separately in both patients' histories of prior hospitalization of acute pancreatitis (adjusted HR 0.97; 95% CI: 0.76-1.24) and those with hypertriglyceridemia (adjusted HR 0.86; 95% CI: 0.65-1.13). No significant association was found for different durations or accumulative doses of sitagliptin. In the stratified analysis, no significant effect modification was found in relation to patients' characteristics. Use of sitagliptin was not associated with an increased risk of acute pancreatitis in high-risk diabetic patients with hypertriglyceridemia or with history of acute pancreatitis.
authors.affiliation: From the Institute of Preventive Medicine, College of Public Health, National Taiwan University (C-HC, S-TC, M-SL, L-MC), Department of Medicine, College of Medicine (C-HC, J-WL, L-MC, Y-CC), and Graduate Institute of Medical Genomics and Proteomics (Y-CC), Taipei, Taiwan; Department of Internal Medicine (C-HC, L-MC, Y-CC) and Center for Obesity, Life Style and Metabolic Surgery (Y-CC), National Taiwan University Hospital, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan (J-WL); Institute of Biomedical Science, Academia Sinica, Taipei, Taiwan (Y-CC).
authors.forename: Chia-Hsuin
authors.initials: CH
authors.lastname: Chang
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Shu-Ting
authors.initials: ST
authors.lastname: Chen
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
authors.forename: Lee-Ming
authors.initials: LM
authors.lastname: Chuang
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Chang
mesh_terms: D020909:Acarbose / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D000068900:Sitagliptin Phosphate / Q000627:therapeutic use; D013624:Taiwan / Q000453:epidemiology
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D020909:Acarbose; D000068900:Sitagliptin Phosphate