Association of DPP-4 inhibitors with respiratory and cardiovascular complications in patients with COPD: a nationwide cohort study.

Aims: COPD is a comorbid condition often associated with type 2 diabetes (T2D) and cardiovascular diseases, but few studies have observed the impact of various antidiabetic drugs in patients with COPD and T2D. We conducted this study to investigate the long-term outcomes of dipeptidyl peptidase-4 (DPP-4) inhibitor use in patients with COPD and T2D. Materials and methods: We recruited 55 924 pairs of propensity score-matched DPP-4 inhibitor users and nonusers from Taiwan's National Health Insurance Research Database between 1 January 2008 and 31 December 2020. We used the Cox proportional hazards models with robust sandwich se estimates to compare the risks of all-cause mortality, major adverse cardiovascular events (MACEs) and respiratory outcomes in participants with COPD and T2D. Results: Compared with no use of DPP-4 inhibitors, the adjusted hazard ratios (aHRs) (95% confidence interval (CI)) for DPP-4 inhibitor use for all-cause mortality, MACEs, hospitalisation for COPD, invasive mechanical ventilation, bacterial pneumonia and lung cancer were 0.47 (0.45-0.49), 0.92 (0.88-0.95), 0.73 (0.62-0.85), 0.76 (0.71-0.82), 0.73 (0.70-0.76) and 0.74 (0.71-0.78), respectively. DPP-4 inhibitor users also exhibited a significantly lower cumulative incidence of hospitalisation for COPD (log-rank test, p=0.004), mechanical ventilation (log-rank test, p<0.001), lung cancer (log-rank test, p<0.001), bacterial pneumonia (log-rank test, p<0.001) and mortality (log-rank test, p<0.001) than nonusers. Conclusions: This nationwide cohort study showed that DPP-4 inhibitor use was associated with a significantly lower risk of mortality, cardiovascular events, respiratory complications and lung cancer in patients with COPD and T2D. Patients with COPD may benefit from DPP-4 inhibitors.