Risk for Angioedema with the Use of Dipeptidyl Peptidase 4 Inhibitors: A Population-Based Cohort Study.

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-06-07 DOI:10.1016/j.jaip.2025.05.060

Bin Hong, Hyesung Lee, Jae Hyun Bae, Young Min Cho, Ju-Young Shin

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引用次数: 0

Abstract

Background: Dipeptidyl peptidase 4 (DPP4) inhibitors, which are widely used antidiabetic medications, may induce the accumulation of bradykinin and substance P, and thus possibly increase the risk for angioedema.

Objective: To assess the risk for angioedema with the use of DPP4 inhibitors compared with other second-line oral antidiabetics (OADs) in patients with type 2 diabetes (T2D).

Methods: A cohort study was conducted using a nationwide healthcare data of South Korea (2010-2022). Patients aged over 40, with T2D, initiating DPP4 inhibitors or other second-line OADs were included. The primary outcome was angioedema, and the secondary outcome was serious angioedema. Hazard ratio (HR) and rate difference (RD) per 1000 person-years between DPP4 inhibitors and other OADs were estimated within a 1:1 propensity score-matched cohort.

Results: This study included 1 410 173 patients initiating DPP4 inhibitors and 966 137 patients initiating other second-line OADs, 99.1% of whom were not using concomitant angiotensin-converting enzyme (ACE) inhibitor due to prescription patterns in South Korea. Over a 1.5-year mean follow-up, no difference in the risk for angioedema with the use of DPP4 inhibitors versus OADs was observed (0.47 and 0.48 events per 1000 person-years, respectively), with an HR of 0.99 [95% CI, 0.89 to 1.12] and a RD of -0.01 [95% CI, -0.07 to 0.05] per 1000 person-years, respectively. The risk for serious angioedema did not increase (RD, -0.001 [95% CI, -0.006 to 0.004]; HR, 0.73 [95% CI, 0.15 to 3.65].

Conclusions: In this large cohort study, the use of DPP4 inhibitors, with 99.1% of users not on concomitant ACE inhibitor therapy, was not associated with an increased risk for angioedema compared with other second-line OADs. However, further studies are needed to determine this risk in those on ACE inhibitor treatment.

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使用二肽基肽酶4抑制剂导致血管性水肿的风险：一项基于人群的队列研究

背景：二肽基肽酶4 （DPP4）抑制剂是广泛应用的降糖药物，可诱导缓激肽和P物质的积累，从而可能增加血管性水肿的风险。目的：评估2型糖尿病（T2D）患者使用DPP4抑制剂与其他二线口服降糖药（OADs）相比发生血管性水肿的风险。方法：采用韩国2010-2022年全国卫生保健数据进行队列研究。患者年龄超过40岁，患有T2D，启动DPP4抑制剂或其他二线oad。主要结局为血管性水肿，次要结局为严重血管性水肿。在1:1倾向评分匹配的队列中估计DPP4抑制剂和其他oad之间每1000人年的风险比（HR）和率差（RD）。结果：本研究纳入了1410173例启动DPP4抑制剂的患者和966137例启动其他二线oad的患者，其中99.1%的患者由于韩国的处方模式而未同时使用血管紧张素转换酶（ACE）抑制剂。在1.5年的平均随访中，观察到使用DPP4抑制剂与OADs的血管性水肿风险无差异（分别为0.47和0.48事件/ 1000人年），HR为0.99 [95% CI， 0.89至1.12]，RD为-0.01 [95% CI, -0.07至0.05]/ 1000人年。严重血管性水肿的风险未增加(RD, -0.001 [95% CI, -0.006至0.004]；HR, 0.73 [95% CI, 0.15 ~ 3.65]。结论：在这项大型队列研究中，与其他二线oad相比，使用DPP4抑制剂（99.1%的使用者未同时使用ACE抑制剂治疗）与血管性水肿风险增加无关。然而，需要进一步的研究来确定接受ACE抑制剂治疗的患者的这种风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.