METHODS: This retrospective cohort study was based on the Taiwan National Health Insurance database. The study population comprised patients with DM, and those who first used SGLT-2is during 2016-2018 were assigned to the study group. Greedy propensity score matching was performed to select patients who first used dipeptidyl peptidase 4 inhibitors (DPP-4is), and these patients were assigned to the control group. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for cancer risk in the study and control groups; this model was adjusted for demographic characteristics, DM severity, comorbidities and concomitant medication use.
RESULTS: After controlling for relevant variables, the SGLT-2i cohort (aHR = 0.90, 95% CI = 0.87-0.93) had a significantly lower risk of developing cancer than the DPP-4i cohort, particularly when the SGLT-2i was dapagliflozin (aHR = 0.91, 95% CI = 0.87-0.95) or empagliflozin (aHR = 0.90, 95% CI = 0.86-0.94). Regarding cancer type, the SGLT-2i cohort\'s risk of cancer was significantly lower than that of the DPP-4i cohort for leukaemia, oesophageal, colorectal, liver, pancreatic, lung, skin and bladder cancer.
CONCLUSIONS: SGLT-2i use was associated with a significantly lower risk of cancer than DPP-4i use.
方法:本回顾性队列研究基于台湾国民健康保险数据库。研究人群包括DM患者,在2016-2018年首次使用SGLT-2is的患者被分配到研究组.进行贪婪倾向评分匹配以选择首次使用二肽基肽酶4抑制剂(DPP-4is)的患者,这些患者被分配到对照组。Cox比例风险模型用于估计研究组和对照组癌症风险的调整风险比(aHRs)和95%置信区间(CIs);该模型针对人口统计特征进行了调整,DM严重程度,合并症和合并用药。
结果:控制相关变量后,SGLT-2i队列(aHR=0.90,95%CI=0.87-0.93)患癌症的风险显著低于DPP-4i队列,特别是当SGLT-2i为达格列净(aHR=0.91,95%CI=0.87-0.95)或依格列净(aHR=0.90,95%CI=0.86-0.94)时.关于癌症类型,SGLT-2i队列的癌症风险显著低于DPP-4i队列的白血病风险,食道,结直肠,肝脏,胰腺,肺,皮肤癌和膀胱癌.
结论:与使用DPP-4i相比,使用SGLT-2i与癌症风险显著降低相关。