Introduction and Objective: Patients with type 2 diabetes (T2D) are at increased risk of acute pancreatitis (AP) and biliary events. Existing evidence is mixed regarding the association between second-line diabetes medications and AP and biliary events.Methods: Using Medicare and 2 U.S. private health plans (2014-2021), we identified three pairwise cohorts of propensity score (PS) fine stratification-weighted patients aged ≥18 years (≥66 years in Medicare) with T2D without a history of AP and biliary disease who initiated GLP-1RA, SGLT2i or DPP4i (Table). PS was estimated by time (2014-2018; 2019-2021) using 92 covariates. We calculated HRs with 95% CIs for the risk of hospitalization for AP or biliary events. We tested the robustness of our findings using different PS-based methods (Table).Results: Over a mean follow-up of ~10 months, the risk of AP was similar across three medication classes (Table). Compared to SGLT2i, initiators of GLP-1RA or DPP4i had a 15% and 22% increase in risk of biliary events, respectively, though the absolute magnitude of the increase in risk was limited (< 1 additional biliary event per 1,000 person-years). Results were consistent across four PS-based methods.Conclusion: In patients with T2D, initiation of GLP-1RA or DPP4i was associated with a higher risk of biliary events compared to SGLT2i, with no observed difference in the risk of AP between medications.
Y.E. Fang: None. H. Tesfaye: None. J. Ortega-Montiel: None. J.M. Paik: None. E. Patorno: Research Support; National Institute of Diabetes and Digestive and Kidney Diseases, Patient-Centered Outcomes Research Institute, Food and Drug Administration (FDA), Boehringer-Ingelheim. Other Relationship; UpToDate.
Patient-Centered Outcomes Research Institute (DB-2020C2-20326)
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