Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.1011
Peer-review started: February 11, 2024
First decision: February 19, 2024
Revised: March 6, 2024
Accepted: March 19, 2024
Article in press: March 19, 2024
Published online: May 15, 2024
Processing time: 91 Days and 9.6 Hours
Inhibitors of dipeptidyl peptidase-4, also known as dipeptidyl-peptidase 4 (DPP-4) inhibitors, represent a widely adopted category of oral hypoglycemic medications favored for managing type 2 diabetes mellitus (T2DM), attributable to their efficacy in reducing blood sugar levels and favorable patient tolerability. However, given the role of DPP-4 in immune function, understanding the association between DPP-4 inhibitor use and infection risk is crucial for treatment adherence and long-term glycemic control.
Previous studies have reported conflicting results regarding the infection risk linked to the application of DPP-4 inhibitors in individuals with T2DM. With diabetes patients already at an increased risk for various infections, clarifying the safety profile of DPP-4 inhibitors in terms of infection risk is essential for informed clinical decision-making.
This meta-analysis aims to assess the risk of overall, serious, opportunistic, and site-specific infections in T2DM patients treated with DPP-4 inhibitors, using data extracted from cardiovascular outcome trials (CVOTs).
A literature search across multiple databases was conducted to identify randomized controlled CVOTs contrasting DPP-4 inhibitors against placebos or operative antidiabetic substances in adult T2DM patients. Cumulative relative risks were calculated employing both random-effects and fixed-effects frameworks, considering the diversity of the trials included.
Six trials involving 53616 patients were included. The assessment uncovered that DPP-4 inhibitors' usage did not markedly escalate the risk of overall, serious, opportunistic, or site-specific infections. This was consistent across various infection types, including respiratory, urinary tract, abdominal, gastrointestinal, skin, soft tissue, bone, and bloodstream infections.
The results suggest that DPP-4 inhibitors do not correlate with a heightened infection risk relative to control groups. This supports the continued use of DPP-4 inhibitors in T2DM therapy without added concerns for heightened infection risk.
While the current meta-analysis provides reassurance about the infection risk associated with DPP-4 inhibitors, further long-term studies and real-world data are essential to thoroughly grasp the consequences of DPP-4 inhibition concerning infection susceptibility. This will help refine treatment strategies for T2DM patients, particularly those at high risk for cardiovascular events.