1862-LB：胰高血糖素样肽 1 受体激动剂与 2 型糖尿病患者自杀和自残的风险

IF 6.2 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes Pub Date : 2024-06-21 DOI:10.2337/db24-1862-lb

SAMANTHA SHAPIRO, LAURENT AZOULAY, HUI YIN, ORIANA HOI YUN YU, SOHAM REJ, SAMY SUISSA

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引用次数: 0

摘要

引言及amp; 目的：有关胰高血糖素样肽-1受体激动剂（GLP-1 RAs）使用者出现自杀和自残念头的报道日益增多，促使多个监管机构对该类药物进行审查。目前迫切需要在现实世界中评估这类药物的安全性。我们试图确定，与二肽基肽酶-4（DPP-4）抑制剂相比，在 2 型糖尿病患者中使用 GLP-1 RA 是否会增加自杀和自残的风险。研究方法利用英国的初级保健、住院和死亡数据，我们对 2007 年 1 月至 2020 年 12 月期间新开具 GLP-1 RA 或 DPP-4 抑制剂处方的 2 型糖尿病患者进行了队列分析。我们使用倾向评分精细分层加权法来平衡暴露组的 40 多种潜在混杂因素，包括年龄、性别、吸烟、体重指数、精神疾病史以及与自残和自杀未遂相关的行为、社会经济状况、糖尿病严重程度替代指标、常见合并症、其他药物使用情况以及寻求健康行为指标。采用治疗暴露定义对患者进行随访。我们采用加权考克斯比例危险模型来估算自杀或自残事件的危险比（HRs）和95%置信区间（CIs）。结果队列包括 36,083 名 GLP-1 RAs 新用户和 234,186 名 DPP-4 抑制剂新用户。粗略分析表明，使用 GLP-1 RA 的自杀和自残风险增加了两倍（HR 1.99，95% CI 1.65-2.41）；然而，加权模型显示风险没有增加（HR 0.99，95% CI 0.77-1.29）。结论在这项基于英国人口的大型研究中，使用 GLP-1 RAs 与自杀或自残风险增加无关。自杀和自残念头报告的增加可能是由于混杂因素造成的，而非因果关系。披露 S. Shapiro：无。L. Azoulay：顾问团；辉瑞公司顾问；罗氏诊断公司。H. Yin：无：无。O. Yu：无。S. Rej：其他关系；艾伯维公司（AbbVie Inc.股票/股东；Aifred Health。S.Suissa：顾问；勃林格殷格翰公司、诺华加拿大公司。Speaker's Bureau; Covispharma.顾问；AtaraBio。Speaker's Bureau; Merck & Co.顾问；Panalgo。资助机构加拿大卫生研究院 (FDN-143328)

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1862-LB: Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Suicide and Self-Harm among Patients with Type 2 Diabetes

Introduction & Objective: Increased reports of thoughts of suicide and self-harm among users of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have prompted multiple regulatory agencies to conduct reviews on the drug class. There is an urgent need to assess the safety of these drugs in a real-world setting. We sought to determine whether GLP-1 RA use is associated with an increased risk of suicide and self-harm when compared with dipeptidyl peptidase-4 (DPP-4) inhibitors among patients with type 2 diabetes. Methods: Using primary care, hospitalization and mortality data from the United Kingdom, we assembled a cohort of patients with type 2 diabetes newly prescribed GLP-1 RAs or DPP-4 inhibitors between January 2007 and December 2020. We used propensity score fine stratification weighting to balance the exposure groups on over 40 potential confounders, including age, sex, smoking, BMI, history of mental health disorders and behaviours associated with self-harm and suicide attempt, socioeconomic status, proxies for diabetes severity, common comorbidities, other medication use, and markers of health-seeking behaviour. Patients were followed using an on-treatment exposure definition. We fit weighted Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident suicide or self-harm. Results: The cohort included 36,083 new users of GLP-1 RAs and 234,186 new users of DPP-4 inhibitors. Crude analyses indicated a twofold increase in the risk of suicide and self-harm associated with GLP-1 RA use (HR 1.99, 95% CI 1.65-2.41); however, the weighted model showed no increased risk (HR 0.99, 95% CI 0.77-1.29). Conclusions: The use of GLP-1 RAs was not associated with an increased risk of suicide or self-harm in this large, population-based study from the United Kingdom. Increased reporting of thoughts of suicide and self-harm are likely due to confounding factors rather than a causal relationship. Disclosure S. Shapiro: None. L. Azoulay: Advisory Panel; Pfizer Inc. Consultant; Roche Diagnostics. H. Yin: None. O. Yu: None. S. Rej: Other Relationship; AbbVie Inc. Stock/Shareholder; Aifred Health. S. Suissa: Consultant; Boehringer-Ingelheim, Novartis Canada. Speaker's Bureau; Covispharma. Consultant; AtaraBio. Speaker's Bureau; Merck & Co., Inc. Consultant; Panalgo. Funding Canadian Institutes of Health Research (FDN-143328)

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来源期刊

Diabetes 医学-内分泌学与代谢

CiteScore

12.50

自引率

2.60%

发文量

1968

审稿时长

1 months

期刊介绍： Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.