Fu-Shun Yen1, James Cheng-Chung Wei2, Hei-Tung Yip3,4, Chii-Min Hwu5,6, Ming-Chih Hou7,8, Chih-Cheng Hsu9,10,11. 1. Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan, 33354, Taiwan. 2. Division of Allergy, Immunology and Rheumatology Chung, Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan. 3. Management Office for Health Data, China Medical University Hospital, 3F., No. 373-2, Jianxing Road, Taichung, 40459, Taiwan. 4. College of Medicine, China Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan. 5. Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec.2, Linong Street, Taipei, 11221, Taiwan. 6. Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan. 7. Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec.2, Linong Street, Taipei, 11221, Taiwan. mchou@vghtpe.gov.tw. 8. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan. mchou@vghtpe.gov.tw. 9. Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan. cch@nhri.edu.tw. 10. Department of Family Medicine, Min-Sheng General Hospital, 168 ChingKuo Road, Taoyuan, 33044, Taiwan. cch@nhri.edu.tw. 11. Department of Health Services Administration, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung, 40402, Taiwan. cch@nhri.edu.tw.
Abstract
BACKGROUND/ PURPOSE: Management of type 2 diabetes mellitus (T2DM) in patients with liver cirrhosis is complex and suboptimal, but no clinical trial has adequately investigated antidiabetic drug use for such patients. We evaluate the risk of mortality, cardiovascular events, and hepatic outcomes between dipeptidyl peptidase-4 (DPP-4) inhibitor users and nonusers in patients with type 2 diabetes mellitus (T2DM) and cirrhosis. METHODS: We selected 2828 paired propensity score matched DPP-4 inhibitor users and nonusers from a cohort of T2DM with compensated liver cirrhosis between January 1, 2007, and December 31, 2012. Cox proportional hazards models were used to assess the risk of main outcomes for DPP-4 inhibitor users. RESULTS: The incidence rate of decompensated cirrhosis during follow-up was 2.20 and 1.53 per 100 patient-years (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.03-1.77) for DPP-4 inhibitor users and nonusers, respectively. The aHRs (95% CI) of variceal bleeding and hepatic failure were 1.67 (1.11-2.52) and 1.35 (1.02-1.79), respectively, for DPP-4 inhibitor users over nonusers. The risk of all-cause mortality, hepatocellular carcinoma, and major cardiovascular events between DPP-4 inhibitor users and nonusers were not statistically different. CONCLUSIONS: This study found that DPP-4 inhibitor users were associated with higher risks of decompensated cirrhosis and hepatic failure than did nonusers among patients with T2DM and compensated liver cirrhosis. We must continue to search for appropriate antidiabetic drugs for patients with liver cirrhosis.
BACKGROUND/ PURPOSE: Management of type 2 diabetes mellitus (T2DM) in patients with liver cirrhosis is complex and suboptimal, but no clinical trial has adequately investigated antidiabetic drug use for such patients. We evaluate the risk of mortality, cardiovascular events, and hepatic outcomes between dipeptidyl peptidase-4 (DPP-4) inhibitor users and nonusers in patients with type 2 diabetes mellitus (T2DM) and cirrhosis. METHODS: We selected 2828 paired propensity score matched DPP-4 inhibitor users and nonusers from a cohort of T2DM with compensated liver cirrhosis between January 1, 2007, and December 31, 2012. Cox proportional hazards models were used to assess the risk of main outcomes for DPP-4 inhibitor users. RESULTS: The incidence rate of decompensated cirrhosis during follow-up was 2.20 and 1.53 per 100 patient-years (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.03-1.77) for DPP-4 inhibitor users and nonusers, respectively. The aHRs (95% CI) of variceal bleeding and hepatic failure were 1.67 (1.11-2.52) and 1.35 (1.02-1.79), respectively, for DPP-4 inhibitor users over nonusers. The risk of all-cause mortality, hepatocellular carcinoma, and major cardiovascular events between DPP-4 inhibitor users and nonusers were not statistically different. CONCLUSIONS: This study found that DPP-4 inhibitor users were associated with higher risks of decompensated cirrhosis and hepatic failure than did nonusers among patients with T2DM and compensated liver cirrhosis. We must continue to search for appropriate antidiabetic drugs for patients with liver cirrhosis.
Authors: Bessie Ann Young; Elizabeth Lin; Michael Von Korff; Greg Simon; Paul Ciechanowski; Evette J Ludman; Siobhan Everson-Stewart; Leslie Kinder; Malia Oliver; Edward J Boyko; Wayne J Katon Journal: Am J Manag Care Date: 2008-01 Impact factor: 2.229
Authors: Diego García-Compeán; Emanuela Orsi; Ramesh Kumar; Felix Gundling; Tsutomu Nishida; Jesús Zacarías Villarreal-Pérez; Ángel N Del Cueto-Aguilera; José A González-González; Giuseppe Pugliese Journal: World J Gastroenterol Date: 2022-02-28 Impact factor: 5.742