Hospitalisation for heart failure and mortality associated with dipeptidyl peptidase 4 (DPP-4) inhibitor use in an unselected population of subjects with type 2 diabetes: a nested case–control study

• Published in: BMJ open 2015-06, Vol.5 (6), p.e007959-e007959
• Main Authors: Giorda, Carlo B, Picariello, Roberta, Tartaglino, Barbara, Marafetti, Lisa, Di Noi, Fabiana, Alessiato, Annalisa, Costa, Giuseppe, Gnavi, Roberto
• Format: Article
• Language: English
• Subjects: Aged; Automation; Bias; Case-Control Studies; Diabetes; Diabetes and Endocrinology; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Diabetic Angiopathies - drug therapy; Diabetic Angiopathies - mortality; Diabetic Angiopathies - prevention & control; Dipeptidyl-Peptidase IV Inhibitors - administration & dosage; Dipeptidyl-Peptidase IV Inhibitors - adverse effects; Drug dosages; Female; Heart attacks; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - prevention & control; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Insurance claims; Male; Mortality; Patient admissions; Population; Risk Factors; Studies; Treatment Outcome
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2015-007959

ObjectiveThe SAVOR TIMI–53 study reported a significant increase in the risk of hospitalisation for heart failure (HF) in patients treated with a DPP-4 inhibitor (DPP-4i) in comparison with placebo. A recent case-control study in part confirmed this risk signal. Our aim was to compare the occurrence of HF in relation to DPP-4i use versus any antidiabetic treatment.DesignPopulation-based matched case-control study conducted using administrative data.SettingThe Italian Region of Piedmont (4.4 million inhabitants).ParticipantsFrom a database of 282 000 patients treated with antidiabetic drugs, we identified 14 613 hospitalisations for HF, 7212 incident cases, and 1727 hospital re-admissions between 2008 and 2012; each case was matched for gender, age and antidiabetic therapy with 10 controls; cases and controls were compared for exposure to DPP-4i.Outcome measuresORs and 95% CIs were calculated by fitting a conditional logistic model. All analyses were adjusted for available risk factors for HF.ResultsWe found no increased risk of hospitalisation for HF associated with the use of DPP-4i (OR for admission for HF 1.00 (0.94 to 1.07), incident HF1.01 (0.92 to 1.11), recurrent HF 1.02 (0.84 to 1.22)). All-cause mortality was 6% lower in DPP-4i users (p