OBJECTIVES:  Recent post-secondary analysis of clinical trials suggested an increased risk of heart failure (HF) with Dipeptidyl Peptidase-4-inhibitors (DPP-4-inhibitors) but the risk remains uncertain. The aim of this study is to assess the risk of HF-hospitalization with the use of DPP-4-inhbitors vs. sulfonylurea in patients with type-II diabetes.

METHODS:  A retrospective cohort analysis using Truven Health-Commercial database was conducted among patients aged >=18 years who had type-II diabetes (ICD-9: 250.x0 or 250.x2). Patients who initiated either DPP-4-inhbitors or sulfonylurea, had no prior use for at least 6 months, and had at least one additional prescription following initiation between January 2008 to December 2015 were included. Patients with a diagnosis of type-I-diabetes, gestational-diabetes, or end-stage-renal-disease prior the index-date (treatment initiation) were excluded. Follow-up continued until the occurrence of first HF-hospitalization, end of enrollment or, end of study period. Cox proportional hazards model after propensity-score matching was used to compare the risk of HF-hospitalization between patients with DPP-4-inhibitors and those with sulfonylurea.

 

RESULTS:  A total of 127,945 new-users of DPP-4-inhbitors [follow-up: Mean (+/- SD):110 days(+/-121)], and 373,208 new-users of sulfonylurea [105 days(+/-114)] were identified. Incidence rates of HF were 101 and 115 per 10,000 person-years in the DPP-4-inhbitors and the sulfonylurea groups, respectively. After matching on propensity-score (n=127945 each) and adjusting for risk factors, DPP-4-inhibitors group experienced 30% risk reduction in HF-hospitalization compared to the sulfonylurea group (HR: 0.70, 95%CI [0.64, 0.77]). Subgroup analysis showed a significant decrease in the risk of HF in patients without any history of cardiovascular disease (CVD) (n=234,299) HR: 0.63, 95%CI [0.56, 0.71]. However, there was no statistically significant difference in the risk of HF between the two groups in patients with prior CVD diagnosis (n=21,591) HR: 0.83, 95%CI [0.69, 1.00].

CONCLUSIONS:  After adjusting for risk factors, the use of DPP-4-inhbitors was associated with reduced risk of HF compared to sulfonylurea.