title: Use of oral antidiabetic agents and risk of community-acquired pneumonia: a nested case-control study.
abstract: OBJECTIVE
  To evaluate the association between use of different oral antidiabetic agents (OAD) and the risk of community-acquired pneumonia (CAP) in patients with type-2 diabetes (T2DM).
  
  
  METHODS
  Case-control study nested in a cohort of patients with T2DM and use of OAD between 2002 and 2013, based in a Spanish general practice research database. Cases were people diagnosed with T2DM, aged >18 years and with a validated diagnosis of CAP between 2002 and 2013. Ten controls were matched on age, sex and calendar year. Odds ratio (OR) of CAP was estimated comparing patients treated with: (1) metformin vs. other monotherapies or no antidiabetic treatment; (2) metformin + sulfonylureas vs. other antidiabetic combinations. OR of CAP was also assessed according to antidiabetic treatment duration.
  
  
  RESULTS
  From a cohort of 76 009 T2DM patients, we identified 1803 cases of CAP. No difference in the incidence of CAP was observed when comparing any OAD in monotherapy with metformin. Compared with current use of metformin + sulfonylurea, thiazolidinediones + metformin was associated with an increased risk of CAP (adjusted OR = 2.48, 95% CI 1.40-4.38). The use of any combination with thiazolidinediones was also associated with higher risk of CAP (adjusted OR = 2.00, 95% CI 1.22-3.28). Current use of DPP-4 inhibitors was not associated with an increased risk of CAP.
  
  
  CONCLUSIONS
  No differences in the incidence of CAP were observed between the use of OAD in monotherapy vs. metformin. Thiazolidinedione use in combination was associated with an increase in the risk of CAP when compared to metformin + sulfonylureas. The use of DPP-4 inhibitors was not associated with an increased risk of CAP.
authors.affiliation: Planning, Evaluation and Management Service, General Directorate of Health, Government of Navarre, Calle Irunlarrea 3 (Pabellón Docencia del Hospital de Navarra), 31008, Pamplona, Navarre, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gorricho
authors.affiliation: Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Garjón
authors.affiliation: Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain.
authors.forename: María Concepción
authors.initials: MC
authors.lastname: Celaya
authors.affiliation: Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Saiz
authors.affiliation: Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Erviti
authors.affiliation: Subdirectorate of Pharmacy, Navarre Regional Health Service, Plaza de la Paz s/n, 31002, Pamplona, Navarre, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: López
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D008687:Metformin / Q000009:adverse effects; D011014:Pneumonia / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology; D013453:Sulfonylurea Compounds / Q000009:adverse effects; D045162:Thiazolidinediones / Q000009:adverse effects
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin
keywords: antidiabetic agents; case-control studies; diabetes mellitus, type 2; incidence; pneumonia