新型降糖药物与二甲双胍与减少哮喘发作之间的关系
2024/05/28
摘要
背景：与二甲双胍类似，基于二肽基肽酶-4抑制剂(DPP-4 Is)、胰高血糖素样肽酶1受体激动剂(GLP-1 RAs)和钠-葡萄糖协同转运蛋白-2抑制剂(SGLT-2 Is) 的多种潜在机制，他们除了不同程度的改善血糖控制、直接的抗炎作用和全身代谢的改变作用，还可以改善哮喘的控制。
目的：探讨在合并2型糖尿病的哮喘患者中，与二甲双胍相比，这些新型降糖药物是否与减少哮喘发作相关。
方法：利用日本国家行政数据库，我们构建了3个对照——由2014—2022年开始使用新型降糖药和二甲双胍的137,173例有哮喘病史的患者组成的新用户队列。采用重叠倾向评分加权均衡患者特征。主要结局是需要全身性皮质类固醇的首次发作，次要结局包括需要全身性皮质类固醇的发作次数。
结果：与二甲双胍相比，DPP-4 Is和GLP-1 RAs与更高的需要全身糖皮质激素治疗的急性发作发生率相关(DPP-4 Is: 18.2 / 100人年对17.4 / 100人年;风险比1.09,1.05～1.14;GLP-1 RAs: 24.9 / 100人年vs. 19.0 / 100人年;1.14, 1.01～1.28)。相比之下，在SGLT-2 Is组和二甲双胍组中，需要全身性皮质类固醇的发作发生率相似(每100人-年17.3例vs. 18.1例;风险比1.00,0.97～1.03)。DPP-4 Is和GLP-1 RAs与更多需要全身性皮质类固醇的发作相关，而SGLT-2 Is与略少的需要全身性皮质类固醇的发作相关(每100人-年53.7次vs. 56.6次;率比0.95,0.91～0.99)。
结论：与二甲双胍相比，DPP-4 Is和GLP-1 RAs的哮喘控制效果较差，而SGLT-2 Is的哮喘控制效果与二甲双胍相当。
Association of novel antihyperglycemic drugs versus metformin with decrease in asthma exacerbations
Yuya Kimura, Taisuke Jo, Norihiko Inoue, Maho Suzukawa, Yohei Hashimoto, Ryosuke Kumazawa, Miho Ishimaru, Hiroki Matsui, Akira Yokoyama, Goh Tanaka, Yusuke Sasabuchi, Hideo Yasunaga
Abstract
Background: Similar to metformin, dipeptidyl peptidase-4 inhibitors (DPP-4 Is), glucagon-like peptidase 1 receptor agonists (GLP-1 RAs), and sodium glucose co-transporter-2 inhibitors (SGLT-2 Is) may improve control of asthma owing to their multiple potential mechanisms, including differential improvements in glycemic control, direct anti-inflammatory effects, and systemic changes in metabolism.
Objective: To investigate whether these novel antihyperglycemic drugs were associated with fewer asthma exacerbations compared with metformin in patients with asthma comorbid with type 2 diabetes.
Methods: Using a Japanese national administrative database, we constructed three active comparators-new user cohorts of 137,173 patients with a history of asthma starting the novel antihyperglycemic drugs and metformin between 2014 and 2022. Patient characteristics were balanced using overlap propensity score weighting. The primary outcome was the first exacerbation requiring systemic corticosteroids, and the secondary outcomes included the number of exacerbations requiring systemic corticosteroids.
Results: DPP-4 Is and GLP-1 RAs were associated with a higher incidence of exacerbations requiring systemic corticosteroids compared with metformin (DPP-4 Is: 18.2 vs. 17.4 per 100 person-years; hazard ratio 1.09, 1.05 to 1.14; GLP-1 RAs: 24.9 vs. 19.0 per 100 person-years; 1.14, 1.01 to 1.28). In contrast, the incidence of exacerbations requiring systemic corticosteroids was similar between the SGLT-2 Is and metformin groups (17.3 vs. 18.1 per 100 person-years; hazard ratio 1.00, 0.97 to 1.03). While DPP-4 Is and GLP-1 RAs were associated with more exacerbations requiring systemic corticosteroids, SGLT-2 Is were associated with slightly fewer exacerbations requiring systemic corticosteroids (53.7 vs. 56.6 per 100 person-years; rate ratio 0.95, 0.91 to 0.99).
Conclusions: While DPP-4 Is and GLP-1 RAs were associated with poorer control of asthma compared with metformin, SGLT-2 Is offered asthma control comparable to that of metformin.
背景：与二甲双胍类似，基于二肽基肽酶-4抑制剂(DPP-4 Is)、胰高血糖素样肽酶1受体激动剂(GLP-1 RAs)和钠-葡萄糖协同转运蛋白-2抑制剂(SGLT-2 Is) 的多种潜在机制，他们除了不同程度的改善血糖控制、直接的抗炎作用和全身代谢的改变作用，还可以改善哮喘的控制。
目的：探讨在合并2型糖尿病的哮喘患者中，与二甲双胍相比，这些新型降糖药物是否与减少哮喘发作相关。
方法：利用日本国家行政数据库，我们构建了3个对照——由2014—2022年开始使用新型降糖药和二甲双胍的137,173例有哮喘病史的患者组成的新用户队列。采用重叠倾向评分加权均衡患者特征。主要结局是需要全身性皮质类固醇的首次发作，次要结局包括需要全身性皮质类固醇的发作次数。
结果：与二甲双胍相比，DPP-4 Is和GLP-1 RAs与更高的需要全身糖皮质激素治疗的急性发作发生率相关(DPP-4 Is: 18.2 / 100人年对17.4 / 100人年;风险比1.09,1.05～1.14;GLP-1 RAs: 24.9 / 100人年vs. 19.0 / 100人年;1.14, 1.01～1.28)。相比之下，在SGLT-2 Is组和二甲双胍组中，需要全身性皮质类固醇的发作发生率相似(每100人-年17.3例vs. 18.1例;风险比1.00,0.97～1.03)。DPP-4 Is和GLP-1 RAs与更多需要全身性皮质类固醇的发作相关，而SGLT-2 Is与略少的需要全身性皮质类固醇的发作相关(每100人-年53.7次vs. 56.6次;率比0.95,0.91～0.99)。
结论：与二甲双胍相比，DPP-4 Is和GLP-1 RAs的哮喘控制效果较差，而SGLT-2 Is的哮喘控制效果与二甲双胍相当。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract. 2024 May 9:S2213-2198(24)00467-7. doi: 10.1016/j.jaip.2024.05.002.)
(J Allergy Clin Immunol Pract. 2024 May 9:S2213-2198(24)00467-7. doi: 10.1016/j.jaip.2024.05.002.)
Association of novel antihyperglycemic drugs versus metformin with decrease in asthma exacerbations
Yuya Kimura, Taisuke Jo, Norihiko Inoue, Maho Suzukawa, Yohei Hashimoto, Ryosuke Kumazawa, Miho Ishimaru, Hiroki Matsui, Akira Yokoyama, Goh Tanaka, Yusuke Sasabuchi, Hideo Yasunaga
Abstract
Background: Similar to metformin, dipeptidyl peptidase-4 inhibitors (DPP-4 Is), glucagon-like peptidase 1 receptor agonists (GLP-1 RAs), and sodium glucose co-transporter-2 inhibitors (SGLT-2 Is) may improve control of asthma owing to their multiple potential mechanisms, including differential improvements in glycemic control, direct anti-inflammatory effects, and systemic changes in metabolism.
Objective: To investigate whether these novel antihyperglycemic drugs were associated with fewer asthma exacerbations compared with metformin in patients with asthma comorbid with type 2 diabetes.
Methods: Using a Japanese national administrative database, we constructed three active comparators-new user cohorts of 137,173 patients with a history of asthma starting the novel antihyperglycemic drugs and metformin between 2014 and 2022. Patient characteristics were balanced using overlap propensity score weighting. The primary outcome was the first exacerbation requiring systemic corticosteroids, and the secondary outcomes included the number of exacerbations requiring systemic corticosteroids.
Results: DPP-4 Is and GLP-1 RAs were associated with a higher incidence of exacerbations requiring systemic corticosteroids compared with metformin (DPP-4 Is: 18.2 vs. 17.4 per 100 person-years; hazard ratio 1.09, 1.05 to 1.14; GLP-1 RAs: 24.9 vs. 19.0 per 100 person-years; 1.14, 1.01 to 1.28). In contrast, the incidence of exacerbations requiring systemic corticosteroids was similar between the SGLT-2 Is and metformin groups (17.3 vs. 18.1 per 100 person-years; hazard ratio 1.00, 0.97 to 1.03). While DPP-4 Is and GLP-1 RAs were associated with more exacerbations requiring systemic corticosteroids, SGLT-2 Is were associated with slightly fewer exacerbations requiring systemic corticosteroids (53.7 vs. 56.6 per 100 person-years; rate ratio 0.95, 0.91 to 0.99).
Conclusions: While DPP-4 Is and GLP-1 RAs were associated with poorer control of asthma compared with metformin, SGLT-2 Is offered asthma control comparable to that of metformin.
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症状特征、知觉因果归因及影响自我照顾行为的环境因素:慢性疾病成人生态日常评估研究
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2型生物标志物低的重度哮喘中的血液转录组特征和哮喘控制
