Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients: A retrospective cohort study

Takuya Imatoh, Takumi Nishi, Midori Yasui, Toshiki Maeda, Kimie Sai, Yoshiro Saito, Hiroshi Une, Akira Babazono

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)931-939
Number of pages9
JournalPharmacoepidemiology and Drug Safety
Volume27
Issue number8
DOIs
Publication statusPublished - Aug 2018

Fingerprint

Dipeptidyl-Peptidase IV Inhibitors
Urinary Tract Infections
Cohort Studies
Retrospective Studies
Prostatic Hyperplasia
Incidence
Propensity Score
Health Insurance
Hypoglycemic Agents
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pharmacology (medical)

Cite this

Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients : A retrospective cohort study. / Imatoh, Takuya; Nishi, Takumi; Yasui, Midori; Maeda, Toshiki; Sai, Kimie; Saito, Yoshiro; Une, Hiroshi; Babazono, Akira.

In: Pharmacoepidemiology and Drug Safety, Vol. 27, No. 8, 08.2018, p. 931-939.

Research output: Contribution to journalArticle

Imatoh, Takuya ; Nishi, Takumi ; Yasui, Midori ; Maeda, Toshiki ; Sai, Kimie ; Saito, Yoshiro ; Une, Hiroshi ; Babazono, Akira. / Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients : A retrospective cohort study. In: Pharmacoepidemiology and Drug Safety. 2018 ; Vol. 27, No. 8. pp. 931-939.
@article{ca9707c4aaa2470b9fabc172a807966b,
title = "Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients: A retrospective cohort study",
abstract = "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.",
author = "Takuya Imatoh and Takumi Nishi and Midori Yasui and Toshiki Maeda and Kimie Sai and Yoshiro Saito and Hiroshi Une and Akira Babazono",
year = "2018",
month = "8",
doi = "10.1002/pds.4560",
language = "English",
volume = "27",
pages = "931--939",
journal = "Pharmacoepidemiology and Drug Safety",
issn = "1053-8569",
publisher = "John Wiley and Sons Ltd",
number = "8",

}

TY - JOUR

T1 - Association between dipeptidyl peptidase-4 inhibitors and urinary tract infection in elderly patients

T2 - A retrospective cohort study

AU - Imatoh, Takuya

AU - Nishi, Takumi

AU - Yasui, Midori

AU - Maeda, Toshiki

AU - Sai, Kimie

AU - Saito, Yoshiro

AU - Une, Hiroshi

AU - Babazono, Akira

PY - 2018/8

Y1 - 2018/8

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85047827148&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047827148&partnerID=8YFLogxK

U2 - 10.1002/pds.4560

DO - 10.1002/pds.4560

M3 - Article

C2 - 29851174

AN - SCOPUS:85047827148

VL - 27

SP - 931

EP - 939

JO - Pharmacoepidemiology and Drug Safety

JF - Pharmacoepidemiology and Drug Safety

SN - 1053-8569

IS - 8

ER -