Wade Thompson, Bing Yu, Joan Porter, Jiming Fang, Laura E Ferreira-Legere, Peter C Austin, Cynthia A Jackevicius, Heather Ross, Douglas S Lee, Alanna Weisman, Michael E Farkouh, Andrea S Gershon, Clare L Atzema, Jeffrey C Kwong, Andrew Ha, Vladimír Džavík, Jacob A Udell
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We compared the risk of both COVID-19 infection as well as adverse outcomes between users of DPP4i or GLP1RA and users of sodium-glucose cotransporter-2 inhibitors (SGLT2is) or sulfonylureas (SUs). The study population was persons ≥66 years with T2DM taking metformin who had ≥1 COVID-19 PCR test between January 2020 and July 2021. We compared (1) COVID-19 infection and (2) adverse outcomes at 30 days among COVID-19 positive patients (major cardiovascular (CV) events, hospitalizations, intensive care unit admission, all-cause mortality, venous thromboembolism, mechanical ventilation). We reported weighted risk differences (RDs) and relative risks (RRs).</p><p><strong>Results: </strong>There were 26,485 DPP4i/GLP1RA users (mean age 76, 47% female, 91% DPP4i users) and 14,487 SGLT2i/SU users (mean age 75, 39% female, 65% SGLT2i users). The weighted rate of COVID-19 infection in DPP4i/GLP1RA users was 10.3% compared with 10.4% among SGLT2i/SU users (weighted RD -0.06, 95% CI -0.79 to 0.66; RR 0.99, 95% CI 0.93 to 1.07). Among COVID-19 positive patients, the weighted RD for all-cause hospitalization for DPP4i/GLP1RA users versus SGLT2i/SU users was -6.72% (95% CI -3.02 to -10.4) and the adjusted weighted RR was 0.79 (95% CI 0.70 to 0.89). For major CV events, the weighted RD was -1.91% (95% CI -4.00 to 0.18) and RR 0.73 (95% CI 0.54 to 1.00).</p><p><strong>Conclusions: </strong>DPP4i/GLP1RA use was not associated with reduced risk of COVID-19 infection compared with SGLT2i/SU use. 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引用次数: 0
摘要
2型糖尿病（T2DM）患者发生COVID-19不良后果的风险较高。二肽基肽酶-4抑制剂（DPP4is）和胰高血糖素样肽-1受体激动剂（GLP1RAs）可能对COVID-19结局有有利影响。研究设计和方法：我们在加拿大安大略省进行了一项基于人群的队列研究。我们比较了DPP4i或GLP1RA使用者与钠-葡萄糖共转运蛋白-2抑制剂（SGLT2is）或磺脲类药物（SUs）使用者之间的COVID-19感染风险和不良结局。研究人群为≥66岁的T2DM患者，服用二甲双胍，在2020年1月至2021年7月期间进行≥1次COVID-19 PCR检测。我们比较了(1)COVID-19阳性患者30天内的COVID-19感染和(2)不良结局（主要心血管（CV）事件、住院、重症监护病房入院、全因死亡率、静脉血栓栓塞、机械通气）。我们报告了加权风险差异（RDs）和相对风险（RRs）。结果：共有26485名DPP4i/GLP1RA用户（平均年龄76岁，女性47%，DPP4i用户91%）和14487名SGLT2i/SU用户（平均年龄75岁，女性39%，SGLT2i用户65%）。DPP4i/GLP1RA使用者中COVID-19的加权感染率为10.3%，而SGLT2i/SU使用者中为10.4%(加权RD为-0.06,95% CI为-0.79 ~ 0.66；RR 0.99, 95% CI 0.93 ~ 1.07)。在COVID-19阳性患者中，DPP4i/GLP1RA使用者与SGLT2i/SU使用者全因住院的加权RD为-6.72% (95% CI为-3.02至-10.4)，调整后加权RR为0.79 （95% CI为0.70至0.89）。对于主要CV事件，加权RD为-1.91% (95% CI -4.00至0.18)，RR为0.73 （95% CI 0.54至1.00）。结论：与使用SGLT2i/SU相比，使用DPP4i/GLP1RA与降低COVID-19感染风险无关。使用DPP4i/GLP1RA与COVID-19阳性老年人住院30天的风险降低有关，并可能有降低心血管事件相关风险的趋势。
Association between dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists and COVID-19 infection and adverse outcomes: a cohort study.
Introduction: People with type 2 diabetes (T2DM) have an elevated risk of adverse outcomes from COVID-19. Dipeptidyl peptidase-4 inhibitors (DPP4is) and glucagon-like peptide-1 receptor agonists (GLP1RAs) might have favorable effects on COVID-19 outcomes.
Research design and methods: We conducted a population-based cohort study in Ontario, Canada. We compared the risk of both COVID-19 infection as well as adverse outcomes between users of DPP4i or GLP1RA and users of sodium-glucose cotransporter-2 inhibitors (SGLT2is) or sulfonylureas (SUs). The study population was persons ≥66 years with T2DM taking metformin who had ≥1 COVID-19 PCR test between January 2020 and July 2021. We compared (1) COVID-19 infection and (2) adverse outcomes at 30 days among COVID-19 positive patients (major cardiovascular (CV) events, hospitalizations, intensive care unit admission, all-cause mortality, venous thromboembolism, mechanical ventilation). We reported weighted risk differences (RDs) and relative risks (RRs).
Results: There were 26,485 DPP4i/GLP1RA users (mean age 76, 47% female, 91% DPP4i users) and 14,487 SGLT2i/SU users (mean age 75, 39% female, 65% SGLT2i users). The weighted rate of COVID-19 infection in DPP4i/GLP1RA users was 10.3% compared with 10.4% among SGLT2i/SU users (weighted RD -0.06, 95% CI -0.79 to 0.66; RR 0.99, 95% CI 0.93 to 1.07). Among COVID-19 positive patients, the weighted RD for all-cause hospitalization for DPP4i/GLP1RA users versus SGLT2i/SU users was -6.72% (95% CI -3.02 to -10.4) and the adjusted weighted RR was 0.79 (95% CI 0.70 to 0.89). For major CV events, the weighted RD was -1.91% (95% CI -4.00 to 0.18) and RR 0.73 (95% CI 0.54 to 1.00).
Conclusions: DPP4i/GLP1RA use was not associated with reduced risk of COVID-19 infection compared with SGLT2i/SU use. DPP4i/GLP1RA use was associated with reduced risk of 30-day hospitalization among COVID-19 positive older adults and a possible trend towards a lower associated risk of CV events.
期刊介绍：
BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of
high-quality — and evidence-based — original research articles.
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