SGLT‐2 inhibitors and the risk of hospitalization for community‐acquired pneumonia: A population‐based cohort study

• Published in: Pharmacoepidemiology and drug safety 2021-06, Vol.30 (6), p.740-748
• Main Authors: Brunetti, Vanessa C., Reynier, Pauline, Azoulay, Laurent, Yu, Oriana Hoi Yun, Ernst, Pierre, Platt, Robert W., Filion, Kristian B.
• Format: Article
• Language: English
• Subjects: Cohort analysis; Cohort Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Dipeptidyl-peptidase IV; Dipeptidyl-Peptidase IV Inhibitors; Genitourinary tract; GLP-1 receptor agonists; Glucagon; Glucose transporter; Hospitalization; Humans; Hypoglycemic Agents - adverse effects; Peptidase; Pneumonia; Pneumonia - chemically induced; Pneumonia - epidemiology; Population studies; Population-based studies; SGLT‐2 inhibitor; Sodium-Glucose Transporter 2 Inhibitors; stype 2 diabetes
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.5192

Purpose Sodium‐glucose co‐transporter 2 inhibitors (SGLT‐2i) have been associated with an increased risk of genitourinary tract infections. Through similar biological mechanisms, they may also increase the risk of community‐acquired pneumonia. Our objective was to compare the rate of hospitalization for community‐acquired pneumonia (HCAP) with SGLT‐2i compared to dipeptidyl peptidase‐4 inhibitors (DPP‐4i) among patients with type 2 diabetes. Methods We used the United Kingdom's Clinical Practice Research Datalink Gold, linked to hospitalization data, to construct a cohort of patients with type 2 diabetes. Using a time‐dependent Cox proportional hazards model, we estimated the adjusted hazard ratio (HR) for HCAP with current use of SGLT‐2i versus DPP‐4i. Results Among 29 896 patients, 705 HCAPs occurred over a mean follow‐up of 1.7 years (SD: 1.2). Incidence rates for SGLT‐2i and DPP‐4i users were 6.2 (95% confidence interval [CI]: 3.7, 10.2) and 17.8 (95% CI: 15.3, 20.7) per 1000 person‐years, respectively. Current use of SGLT‐2i was associated with a decreased risk of HCAP compared to current use of DPP‐4i (adjusted HR: 0.48, 95% CI: 0.28, 0.82). However, a comparison of SGLT‐2i versus glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) found no difference in risk of HCAP (adjusted HR: 0.94, 95% CI: 0.44, 1.89). Conclusions SGLT‐2i are associated with a decreased rate of HCAP compared to DPP‐4i, but not when compared to GLP‐1 RA, among patients with type 2 diabetes.