Type 2 diabetes is a common disease characterised by elevated blood sugar levels. It is a major cause of cardiovascular disorders and may lead to kidney disease, blindness, and death. Dipeptidyl peptidase-4 (DPP-4) inhibitors are relatively new and effective second-to-third line antidiabetic drugs, which can decrease blood sugar levels. They have less side effects that other antidiabetic drugs. However, there are emerging concerns that they may be associated with rheumatoid arthritis, a chronic autoimmune disorder primarily affecting joints, and leading to disability. Therefore, this study will determine whether the use of DPP-4 inhibitors in patients with type 2 diabetes is related to an increase in the risk of rheumatoid arthritis using the Clinical Practice Research Datalink. This will be investigated using a group of over 130,000 patients with type 2 diabetes, where the users of DPP-4 inhibitors will be compared to the users of other antidiabetic drugs. The findings of this study will add to the current safety profile of DPP-4 inhibitors.
Dipeptidyl peptidase-4 (DPP-4) inhibitors are effective second-to-third line antidiabetic drugs. Recently, there has been a controversy regarding their potential association with rheumatoid arthritis (RA). While several case reports have suggested a link between their use and the development of RA, an observational study showed a 34% decreased risk. Therefore, the primary objective of this study is to determine whether there is an association between the use of DPP-4 inhibitors and the risk of RA in patients with type 2 diabetes. For this purpose, we will assemble a cohort of patients, at least 18 years old, newly-treated with non-insulin antidiabetic drugs between January 1, 1988 and June 30, 2016, with follow up until June 30, 2017. Use of DPP-4 inhibitors will be modelled as a time-varying variable, where patients will be considered unexposed to DPP-4 inhibitors until 6 months after the first prescription for latency. Time-dependent Cox proportional hazards models will be used to estimate hazard ratios with 95% confidence intervals of RA associated with use of DPP-4 inhibitors, compared with use of all other antidiabetic drugs. Secondary analyses will assess whether risk varies by cumulative duration of use and time since initiation, and whether there is a drug specific effect.
Incidence of rheumatoid arthritis among patients with type 2 diabetes.
Samy Suissa - Chief Investigator - Sir Mortimer B Davis Jewish General Hospital
Laurent Azoulay - Corresponding Applicant - McGill University
Antonios Douros - Collaborator - McGill University
Christel Renoux - Collaborator - McGill University
Devin Abrahami - Collaborator - McGill University
Hui Yin - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Marie Hudson - Collaborator - McGill University
Oriana Hoi Yun Yu - Collaborator - Sir Mortimer B Davis Jewish General Hospital