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Association between dipeptidyl peptidase‐4 inhibitors and urinary tract infection in elderly patients: A retrospective cohort study
Author(s) -
Imatoh Takuya,
Nishi Takumi,
Yasui Midori,
Maeda Toshiki,
Sai Kimie,
Saito Yoshiro,
Une Hiroshi,
Babazono Akira
Publication year - 2018
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4560
Subject(s) - medicine , urinary system , retrospective cohort study , pharmacoepidemiology , dipeptidyl peptidase 4 , cohort study , cohort , pharmacology , diabetes mellitus , endocrinology , type 2 diabetes , medical prescription
Purpose Dipeptidyl peptidase‐4 (DPP‐4) inhibitors are a new class of antidiabetic drugs. Although they have been reported to increase the risk of infection, the findings are controversial. Given that urinary tract infections (UTIs) are common in the elderly, we conducted a retrospective cohort study by using health care insurance claims data, to elucidate the association between the DPP‐4 inhibitors and the incidence of UTI in latter‐stage elderly patients. Methods We analyzed 25,111 Japanese patients aged 75 years and older between the fiscal years 2011 and 2016. Patients using DPP‐4 inhibitors and sulfonylureas (SUs) were matched at a 1:1 ratio using propensity scoring. The Incidence rate ratio (IRR) of UTI was compared between users of SUs and users of DPP‐4 inhibitors by Poisson regression. Moreover, subgroup analyses stratified by sex were conducted to evaluate whether the combination of prostatic hyperplasia and DPP‐4 inhibitors is associated with the incidence of UTI in male patients. Results The use of DPP‐4 inhibitors was associated with an increased risk of UTI (adjusted IRR 1.23, 95% CI [1.04‐1.45]). After propensity score matching, the association remained significant (adjusted IRR 1.28, 95% CI [1.05‐1.56]). Moreover, elderly male patients with prostatic hyperplasia who received DPP‐4 inhibitors had a higher risk of UTI than SU users without prostatic hyperplasia (Matched: crude IRR 2.90, 95% CI [1.78‐4.71]; adjusted IRR 2.32, 95% CI [1.40‐3.84]). Conclusions The long‐term use of DPP‐4 inhibitors by elderly patients, particularly male patients with prostatic hyperplasia, may increase the risk of UTI.