DPP4 inhibitors may increase risk of cholecystitis in T2 Diabetes patients: BMJ

Increased risk of Cholecystitis was found in Type 2 Diabetes patients who were using Dipeptidyl peptidase-4 inhibitors. The study was published in the journal, The BMJ 2022.

Diabetes is a pandemic affecting a larger population across the globe. Multiple drugs were introduced to treat the condition either as monotherapy or as combination therapy. Of these Dipeptidyl peptidase-4 inhibitors are commonly used for the management of Type 2 Diabetics. Recently concern was raised that Dipeptidyl peptidase-4 inhibitors may cause gall bladder or biliary diseases. So, researchers from the Peking Union Medical College Hospital, China conducted a study to examine the association between dipeptidyl peptidase-4 inhibitors and gallbladder or biliary diseases.

Zhang et al conducted a systematic review with pairwise and network meta-analysis to find the association. Using the keywords they conducted a search strategy in various databases like PubMed, EMBASE, Web of Science, and CENTRAL from inception until 31 July 2021. They included randomized controlled trials of adult patients with type 2 diabetes who received dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors compared with placebo or other antidiabetic drugs. The outcomes of measurement were gallbladder or biliary diseases, cholecystitis, cholelithiasis, and biliary diseases. The data were extracted independently and the quality of the studies was assessed by two reviewers. Using the Grading of Recommendations, Assessment, Development, and Evaluations framework (GRADE) approach, the quality of the evidence for each outcome was assessed. Pooled odds ratios and 95% confidence intervals were used for the meta-analysis.

Results:

• 104 833 participants from 82 randomized controlled trials were included in the pairwise meta-analysis.
• Dipeptidyl peptidase-4 inhibitors were significantly associated with an increased risk of the composite of gallbladder or biliary diseases and cholecystitis but not with the risk of cholelithiasis and biliary diseases when compared with placebo or non-incretin drugs.
• The association was seen in diabetics using dipeptidyl peptidase-4 inhibitors for longer duration.
• The meta-analysis revealed that dipeptidyl peptidase-4 inhibitors increased the risk of the composite of gallbladder or biliary diseases and cholecystitis compared with sodium-glucose cotransporter-2 inhibitors but not compared with glucagon-like peptide-1 receptor agonists. 

Thus, the researchers concluded that Dipeptidyl peptidase-4 inhibitors increased the risk of cholecystitis, in patients who are using them for longer duration. They further added that more attention has to be given while prescribing the drug due to the risk of cholecystitis.

For full article, click here:            Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials

BMJ 2022; 377 doi:

https://doi.org/10.1136/bmj-2021-068882