The effect of DPP-4 inhibitors on asthma control: an administrative database study to evaluate a potential pathophysiological relationship

Abstract

RationaleDPP-4 may regulate immunological pathways implicated in asthma. Assessing whether DPP-4 inhibitor (DPP-4i) use might affect asthma control is clinically important because DPP-4i use in type 2 diabetes mellitus management (T2DM) is increasing. This study evaluated associations between DPP-4i use and asthma control.MethodsThis was a retrospective, observational, matched cohort study using administrative claims in the MarketScan® Commercial Claims and Encounters (Commercial) and Medicare Supplemental and Coordination of Benefits (Medicare Supplemental) databases. Adult asthma patients initiating an oral DPP-4i or a non-DPP-4i between November 1, 2006 and March 31, 2014 were included. Patients were followed for asthma-related outcomes for 12 months after initiation of the antidiabetes medication. Outcomes included risk-domain asthma control (RDAC), defined as no asthma hospitalizations, no lower respiratory tract infections, and no oral corticosteroid (OCS) prescriptions; overall asthma control (RDAC criteria plus limited short-acting beta agonist use); treatment stability (RDAC criteria plus no increase of ≥50% in inhaled corticosteroid dose or addition of other asthma therapy); and severe asthma exacerbation rates (asthma-related hospitalizations, emergency room visits, or acute treatments with OCS). Comparisons were made between two matched cohorts (DPP-4i vs. non-DPP-4i initiators) using multivariable logistic regression and generalized linear modeling. Covariates included baseline demographic and clinical characteristics related to asthma and T2DM.ResultsThe adjusted odds of achieving RDAC (odds ratio [OR]: 1.05; 95% CI: 0.964 to 1.147), overall asthma control (OR: 1.04; 95% CI: 0.956 to 1.135), and treatment stability (OR: 1.04; 95% CI: 0.949 to 1.115) did not differ between the DPP-4i and non-DPP-4i cohorts. A difference was not found between cohorts in severe asthma exacerbation rates during the 12 months following initiation of antidiabetes treatment (mean = 0.32 vs. 0.34 exacerbations per subject-year, respectively; p=0.064).ConclusionAsthma control was similar between patients initiating DPP-4i and non-DPP-4i antidiabetes medications, suggesting no association between DPP-4i use and asthma control.

Asthma Exacerbations in Patients with Type 2 Diabetes and Asthma on Glucagon-like Peptide-1 Receptor Agonists

“…Limited observational data from patients with type 2 diabetes mellitus (type 2 DM) without respiratory disease, suggest that glucagon-like peptide-1 receptor (GLP-1R) agonists in combination with metformin may improve baseline pulmonary function (11). However, use of other diabetes therapies such as insulin and DPP-4 inhibitors do not impact incident asthma risk (12,13). Therefore, therapies targeting metabolic pathways may be key to achieving asthma control for a significant proportion of individuals with asthma (14).…”

The Roles of Dipeptidyl Peptidase 4 (DPP4) and DPP4 Inhibitors in Different Lung Diseases: New Evidence

“…However, a retrospective study conducted by Colice showed that there was no significant difference in the asthma control rate between DPP4 inhibitor users and non-users in asthma patients with T2DM. This might be related to the non-specific distribution of oral DPP4 inhibitor ( Colice et al, 2017 ).…”

The Coincidence of Diabetes Mellitus and Asthma, Their Probable Causal Relationships and Therapeutic Opportunities

“…A retrospective, observational cohort study conducted on the basis of American commercial databases, covering the years 2006-2014 and patients with T2DM and asthma, demonstrated that the use of the DPP4 inhibitors, such as alogliptin, linagliptin, saxagliptin, sitagliptin or mixed products containing these agents for a year did not affect significantly the risk-domain asthma control (RDAC), defined as no asthma hospitalizations, no lower respiratory tract infections, and no OGCs prescriptions (OR 1.05, 95% CI 0.964-1.147), total control AS (OR 1.04, 95% CI 0.956-1.135), stability of the therapy (OR 1.04, 95% CI 0.949-1.115) and the number of severe exacerbations (mean = 0.32 vs 0.34 exacerbations per subject-year, respectively; p = 0.064) [45].…”