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ORIGINAL RESEARCH article

Front. Pharmacol.

Sec. Pharmacoepidemiology

Volume 16 - 2025 | doi: 10.3389/fphar.2025.1518545

This article is part of the Research Topic Pharmacoepidemiology in Chronic Diseases View all 7 articles

Association of long-term use of dipeptidyl peptidase-4 inhibitors with the risk of diabetic retinopathy in patients with diabetes mellitus: A real-world evidence study

Provisionally accepted
Yu-Ching Li Yu-Ching Li 1Yu-Hsiang Kuan Yu-Hsiang Kuan 2Yih Yang Yih Yang 3Shuo-Yan Gau Shuo-Yan Gau 4,5Kun-Yu Su Kun-Yu Su 4Tung-Han Tsai Tung-Han Tsai 6Kuang-Hua Huang Kuang-Hua Huang 6*Chien-Ying Lee Chien-Ying Lee 2*
  • 1 Department of Public Health, China Medical University, Taichung, Taiwan
  • 2 Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan, Taichung, Taiwan
  • 3 Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
  • 4 School of Medicine, Chung Shan Medical University, Taichung, Taiwan
  • 5 Department and Graduate Institute of Business Administration, National Taiwan University, Taipei, Taiwan
  • 6 Department of Health Services Administration, China Medical University, Taichung, Taiwan, Taichung, Taiwan

The final, formatted version of the article will be published soon.

    Background: In this study, we investigated the association of long-term use of a dipeptidyl peptidase-4 inhibitor (DPP-4i) with the risk of diabetic retinopathy (DR) in patients with diabetes mellitus (DM).: This study was a secondary analysis based on the nationwide database from 2008 to 2022 in Taiwan. Patients with new-onset DM who were treated with either a DPP-4i or sulfonylurea from 2009 to 2017 were included in this study. Patients who received a DPP-4i were included in the case group and further divided on the basis of the cumulative defined daily dose (cDDD) as follows: ≤90, 91-180, 181-300, and >300 cDDD. Propensity score matching was performed to select patients who used a sulfonylurea, and these patients were assigned to the control group. With adjustment for sex, age, income, urbanization level, comorbidities, and other anti-diabetic agents, the Cox proportional hazard model was used to estimate the risk of DR associated with DPP-4i use over the 5-year follow-up. Results: There were 83 503 patients with DPP-4i use and 167 006 patients with sulfonylurea use after matching. Compared with patients with sulfonylurea use, patients with DPP-4i use at ≤90 cDDD had a hazard ratio (HR) of 1.43 (95% confidence interval [CI] = 1.38-1.49) for DR development, whereas those with DPP-4i use at 91-180,181-300 or >300 cDDD had HRs of 1.66 (95% CI: 1.59-1.74), 1.82 (95% CI: 1.74-1.90), and 2.32 (95% CI: 1.91-2.82) for DR development, respectively. Of the different DPP-4is, linagliptin at ≤90 or 181-300 was associated with the highest risk of DR. Significant differences were discovered at ≤90, 91-181, and 181-300 cDDD in the risk of DR between patients using Saxagliptin versus sitagliptin. Vildagliptin at ≤90 or 91-180 cDDD was associated with an increased risk of DR, but not at 181-300 cDDD.In patients with DM, DPP-4i at ≤90, 91-180, 181-300 and >300 cDDD was linked to an increased risk of DR over the 5-year follow-up. Sitagliptin at cDDD 181-300 was associated with the greatest DR risk. The potential for DPP-4i to accelerate DR progression should be considered.

    Keywords: Diabetic Retinopathy, dipeptidyl peptidase-4 inhibitors, Diabetes Mellitus, cumulative defined daily dose, Real-world evidence

    Received: 28 Oct 2024; Accepted: 28 Mar 2025.

    Copyright: © 2025 Li, Kuan, Yang, Gau, Su, Tsai, Huang and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Kuang-Hua Huang, Department of Health Services Administration, China Medical University, Taichung, Taiwan, Taichung, Taiwan
    Chien-Ying Lee, Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan, Taichung, Taiwan

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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