Dipeptidyl peptidase IV inhibitors and the risk of mycobacterial pulmonary infections in type 2 diabetes mellitus

Cheng-Yi Wang; Kuang-Ming Liao; Ya-Hui Wang; Kuang-Hung Chen; Shulin Chuang; Chia-Jung Liu; Chin-Chung Shu; Hao-Chien Wang

doi:10.1016/j.jiph.2023.08.018

Dipeptidyl peptidase IV inhibitors and the risk of mycobacterial pulmonary infections in type 2 diabetes mellitus

J Infect Public Health. 2023 Nov;16(11):1709-1715. doi: 10.1016/j.jiph.2023.08.018. Epub 2023 Aug 26.

Authors

Cheng-Yi Wang¹, Kuang-Ming Liao², Ya-Hui Wang³, Kuang-Hung Chen⁴, Shulin Chuang⁵, Chia-Jung Liu⁶, Chin-Chung Shu⁷, Hao-Chien Wang⁸

Affiliations

¹ Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
² Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan.
³ Medical Research Center, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
⁶ National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu country, Taiwan.
⁷ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: ccshu@ntu.edu.tw.
⁸ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University College of Medicine, Taipei, Taiwan; National Taiwan University Cancer Center, Taipei, Taiwan.

PMID: 37729686
DOI: 10.1016/j.jiph.2023.08.018

Abstract

Background: Type 2 diabetes mellitus (DM) is a risk factor for mycobacterial pulmonary infections (MPI), including tuberculosis (TB) and nontuberculous mycobacterial lung disease (NTM-LD). Dipeptidyl peptidase IV inhibitor (DPP4i), a common DM medication, has an immune-modulation effect that raises concerns about developing MPI. However, there is scarce research on the topic.

Methods: This retrospective study was conducted in a tertiary-referral center in Taiwan from 2009 to 2016. Patients with type 2 DM who were receiving any DM medication were enrolled. TB and NTM-LD were defined by microbiological criteria. We analyzed the risk of MPI in DPP4i users using Cox proportional hazard regression with adjusted inverse probability of treatment weighting.

Results: A total of 9963 patients were included. Among them, 3931 were classified as DPP4i users, and 6032 patients were DPP4i nonusers. DPP4i users had no increase in incidences of MPI (604 vs. 768 per 100,000 person-years, p = 0.776), NTM-LD (174 vs. 255 per 100,000 person-years, p = 0.228), and TB (542 vs. 449 per 100,000 person-years, p = 0.663) relative to those of DPP4i nonusers. After adjustment, the adjusted hazard ratios for MPI (aHR: 1.07, 95% CI: 0.79-1.45), TB (aHR: 1.15, 95% CI: 0.81-1.64) and NTM-LD (aHR: 0.85, 95% CI: 0.49-1.47) were not significantly increased relative to those of nonusers. The subgroup analysis also showed that DPP4i use did not increase the risk of MPI in different DM severities and comorbidities.

Conclusions: According to our large cohort study, DPP4i use is safe for patients with type 2 DM and might not increase the risk of MPI.

Keywords: Diabetes mellitus; Dipeptidyl peptidase IV inhibitors; Mycobacterial pulmonary infection; Nontuberculous mycobacterial lung disease; Tuberculosis.