Dipeptidyl peptidase 4 (DPP-4) inhibitors do not appear to increase the risk of developing inflammatory bowel disease (IBD), according to a meta-analysis published in the Annals of Pharmacotherapy.

To investigate the association between this diabetes drug class and IBD risk, the study authors searched various databases for controlled clinical trials and observational studies involving DPP-4 inhibitors where IBD events were reported. “The DerSimonian and Laird random-effects model was utilized to assess the relative risk (RR) for IBD post DPP-4 inhibitor exposure,” the authors explained.

Sixteen studies (ranging from 52 weeks to 5 years) evaluating 198,404 patients were included in the analysis. Results showed that exposure to DPP-4 inhibitors was associated with a nonsignificant increase in IBD risk when using the random-effects model (RR 1.52; 95% CI, 0.72-3.24; I2 = 54.2%), however a significant increase was noted in the fixed-effects model (RR 3.01; 95% CI, 2.30-3.93).

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Moreover, in a subgroup analysis, the use of DPP-4 inhibitors was found to significantly increase the risk of Crohn disease (RR 2.47; 95% CI, 1.36-4.48). However, this finding was rendered nonsignificant when the largest study (Abrahami et al) was eliminated from the analysis.

“Although the use of random versus fixed models remains controversial, the fact that both models are largely driven by the inclusion of 1 large study more likely suggests that DPP-4 inhibitors do not increase IBD risk,” stated the authors. “However, long-term postmarketing surveillance is warranted.”

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