Sodium-glucose cotransporter inhibitors may reduce the risk of pneumonia: an updated meta-analysis of cardiovascular outcome trials

Barkas, Fotios; Anastasiou, Georgia; Milionis, Haralampos; Liberopoulos, Evangelos

doi:10.1007/s13340-021-00515-4

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…In a meta-analysis of nine randomised controlled trials, SGLT-2 inhibitors were associated with a trend towards a reduced risk of new onset of chronic obstructive pulmonary disease (risk ratio 0.79, 0.61 to 1.02). 51 Furthermore, large observational studies and a meta-analysis of cardiovascular outcome trials have associated SGLT-2 inhibitors with a decreased risk of pneumonia, 10 11 52 a condition that often leads to chronic obstructive pulmonary disease exacerbations. The mechanisms behind heterogeneous findings of SGLT-2 inhibitors preventing severe but not moderate chronic obstructive pulmonary disease exacerbations are unclear and should be explored further.…”

Section: Discussionmentioning

confidence: 99%

Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

Pradhan

Yin

et al. 2022

BMJ

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Objective To determine whether the use of glucagon-like peptide 1 (GLP-1) receptor agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors, and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, separately, is associated with a decreased risk of exacerbations of chronic obstructive pulmonary disease among patients with chronic obstructive pulmonary disease and type 2 diabetes. Design Population based cohort study using an active comparator, new user design. Setting The United Kingdom Clinical Practice Research Datalink linked with the Hospital Episode Statistics Admitted Patient Care and Office for National Statistics databases. Participants Three active comparator, new user cohorts of patients starting the study drugs (GLP-1 receptor agonists, DPP-4 inhibitors, or SGLT-2 inhibitors) or sulfonylureas with a history of chronic obstructive pulmonary disease. The first cohort included 1252 patients starting GLP-1 receptor agonists and 14 259 starting sulfonylureas, the second cohort included 8731 patients starting DPP-4 inhibitors and 18 204 starting sulfonylureas, and the third cohort included 2956 patients starting SGLT-2 inhibitors and 10 841 starting sulfonylureas. Main outcome measures Cox proportional hazards models with propensity score fine stratification weighting were fitted to estimate hazard ratios and 95% confidence intervals of severe exacerbation of chronic obstructive pulmonary disease (defined as hospital admission for chronic obstructive pulmonary disease), separately for GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors. Whether these drugs were associated with a decreased risk of moderate exacerbation (defined as a co-prescription of an oral corticosteroid and an antibiotic along with an outpatient diagnosis of acute chronic obstructive pulmonary disease exacerbation on the same day) was also assessed. Results Compared with sulfonylureas, GLP-1 receptor agonists were associated with a 30% decreased risk of severe exacerbation (3.5 v 5.0 events per 100 person years; hazard ratio 0.70, 95% confidence interval 0.49 to 0.99) and moderate exacerbation (0.63, 0.43 to 0.94). DPP-4 inhibitors were associated with a modestly decreased incidence of severe exacerbation (4.6 v . 5.1 events per 100 person years; hazard ratio 0.91, 0.82 to 1.02) and moderate exacerbation (0.93, 0.82 to 1.07), with confidence intervals including the null value. Finally, SGLT-2 inhibitors were associated with a 38% decreased risk of severe exacerbation (2.4 v 3.9 events per 100 person years; hazard ratio 0.62, 0.48 to 0.81) but not moderate exacerbation (1.02, 0.83 to 1.27). Conclusions In this population based study, GLP-1 receptor agonists and SGLT-2 inhibitors were associated with a reduced risk of severe exacerbations compared with sulfonylureas in patients with chronic obstructive pulmonary disease and type 2 diabetes. DPP-4 inhibitors were not clearly associated with a decreased risk of chronic obstructive pulmonary disease exacerbations.

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Section: Discussionmentioning

confidence: 99%

Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

Pradhan

Yin

et al. 2022

BMJ

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“…However, similar effects were not reported for other classes of glucose-lowering drugs, including sulfonylurea (10), thiazolidinediones (10), and dipeptidyl peptidase-4 inhibitors (DPP4is) (11), while the association of SGLT2is with pneumonia remains largely unclear. A recent meta-analysis of 8 placebo-controlled clinical trials reported a reduced risk of pneumonia among participants treated with SGLT2is (12). However, clinical trials often include highly selected patients and, hence, compromise the generalizability to the real-world population.…”

Section: Introductionmentioning

confidence: 99%

Association Between SGLT2 Inhibitors vs DPP-4 Inhibitors and Risk of Pneumonia Among Patients With Type 2 Diabetes

Tan

Cheung

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Patients with diabetes are at a higher risk of pneumonia and pneumonia mortality. Sodium-glucose co-transporter 2 inhibitors (SGLT2is), the latest class of glucose-lowering agents, were shown to reduce the risk of pneumonia in clinical trials. However, the real-world effectiveness of SGLT2is on the risk of pneumonia is largely unknown. Objective To investigate the associations between SGLT2is use and the risk of pneumonia and pneumonia mortality compared to dipeptidyl peptidase-4 inhibitors (DPP4is) using an electronic medical database in Hong Kong. Design A retrospective cohort study. The “prevalent new-user” design was adopted to account for the previous exposure to the study drugs being compared. Propensity score (PS) matching (1:4) was used to balance the baseline characteristics of the two groups. Setting and participants Electronic health data of type 2 diabetes patients using SGLT2is and DPP4is between 2015 and 2018 was collected from the Clinical Data Analysis and Reporting System (CDARS). Main Outcome Measures Pneumonia incidence and mortality. Results The PS-matched cohort consisted of 6,664 users of SGLT2is and 26,656 users of DPP4is, with a mean follow-up of 3.8 years. Poisson regression showed that SGLT2is use was associated with lower risk of pneumonia compared to DPP4is with an absolute rate difference of 4.05 per 1000 person-years (95% CI: 2.61-5.51). The corresponding IRR was 0.71 (95% CI: 0.62-0.81). Similar reduction in risk of pneumonia death was observed (HR: 0.57; 95% CI: 0.42-0.77). Conclusion Compared to DPP4is, SGLT2is use was associated with a reduced risk of pneumonia and pneumonia mortality in a real-world setting.

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Comparative risk of infection of medications used for type 2 diabetes

Zapata-Bravo,

Douros,

Yun Yu

et al. 2024

Expert Opinion on Drug Safety

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Sodium-glucose cotransporter inhibitors may reduce the risk of pneumonia: an updated meta-analysis of cardiovascular outcome trials

Cited by 4 publications

References 21 publications

Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study

Association Between SGLT2 Inhibitors vs DPP-4 Inhibitors and Risk of Pneumonia Among Patients With Type 2 Diabetes

Comparative risk of infection of medications used for type 2 diabetes

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