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Umesh Modi is a chartered accountant, and Pamini Jatheeskumar is a chartered certified accountant at Silver Levene...
  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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a stomach cramp imageMarch 29 2018

A study has shown that dipeptidylpeptidase-4 inhibitors may increase the risk of developing of inflammatory bowel disease. However, the absolute risk is considered low.

The researchers say that while their findings need to be replicated, “physicians should be made aware of this possible association.”

Findings were based on records from 141,170 adult patients with diabetes who had been prescribed DPP-4 inhibitors, also known as gliptins, between 2007 and 2016. Participants were monitored for an average of three and a half years, during which time 208 new cases of inflammatory bowel disease were recorded (an incidence rate of 37.7 per 100,000 person years).

Overall, use of DPP-4 inhibitors was associated with a 75% increased risk of inflammatory bowel disease (53.4 cases per 100,000 person years) compared with use of other antidiabetic drugs (34.5 cases per 100,000 person years).

In addition, the association gradually increased the longer the person had been using a DPP-4 inhibitor, peaking at three to four years and then declining slowly. No single DDP-4 inhibitor was associated statistically with inflammatory bowel disease.

“Although the absolute risk is low, physicians should be aware of this possible association and perhaps refrain from prescribing dipeptidyl peptidase-4 inhibitors for people at high risk (that is, those with a family history of disease or with known autoimmune conditions),” said the researchers.

“Moreover, patients presenting with persistent gastrointestinal symptoms such as abdominal pain or diarrhoea should be closely monitored for worsening of symptoms.”

Links:
BMJ announcement   
D Abrahami et al. ‘Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: population based cohort study’. BMJ. Published online March 21 2018. 360:k872

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