Abstract：
OBJECTIVE: To compare the risks of gastric cancer and other gastric diseases in patients with type-2 diabetes mellitus (T2DM) exposed to sodium-glucose cotransporter 2 inhibitors (SGLT2I), dipeptidyl peptidase-4 inhibitors (DPP4I) or glucagon-like peptide-1 receptor agonists (GLP1a).
METHODS: This was a population-based cohort study of prospectively collected data on patients with T2DM prescribed SGLT2I, DPP4I or GLP1a between January 1st 2015 and December 31st 2020 from Hong Kong. The outcomes were new-onset gastric cancer, peptic ulcer (PU), acute gastritis, non-acute gastritis, and gastroesophageal reflux disease (GERD). Propensity score matching (1:1) using the nearest neighbour search was performed, and multivariable Cox regression was applied. A three-arm comparison between SGLT2I, DPP4I and GLP1a was conducted using propensity scores with inverse probability of treatment weighting.
RESULTS: A total of 62,858 patients (median age: 62.2 years old [SD: 12.8]; 55.93% males; SGLT2I: n = 23,442; DPP4I: n = 39,416) were included. In the matched cohort, the incidence of gastric cancer was lower in SGLT2I (Incidence rate per 1000 person-year, IR: 0.32; 95% confidence interval, CI 0.23-0.43) than in DPP4I (IR per 1000 person-year: 1.22; CI 1.03-1.42) users. Multivariable Cox regression found that SGLT2I use was associated with lower risks of gastric cancer (HR 0.30; 95% CI 0.19-0.48), PU, acute gastritis, non-acute gastritis, and GERD (p < 0.05) compared to DPP4I use. In the three-arm analysis, GLP1a use was associated with higher risks of gastric cancer and GERD compared to SGLT2I use.
CONCLUSIONS: The use of SGLT2I was associated with lower risks of new-onset gastric cancer, PU, acute gastritis, non-acute gastritis, and GERD after matching and adjustments compared to DPP4I use. SGLT2I use was associated with lower risks of GERD and gastric cancer compared to GLP1a use.
METHODS: This was a population-based cohort study of prospectively collected data on patients with T2DM prescribed SGLT2I, DPP4I or GLP1a between January 1st 2015 and December 31st 2020 from Hong Kong. The outcomes were new-onset gastric cancer, peptic ulcer (PU), acute gastritis, non-acute gastritis, and gastroesophageal reflux disease (GERD). Propensity score matching (1:1) using the nearest neighbour search was performed, and multivariable Cox regression was applied. A three-arm comparison between SGLT2I, DPP4I and GLP1a was conducted using propensity scores with inverse probability of treatment weighting.
RESULTS: A total of 62,858 patients (median age: 62.2 years old [SD: 12.8]; 55.93% males; SGLT2I: n = 23,442; DPP4I: n = 39,416) were included. In the matched cohort, the incidence of gastric cancer was lower in SGLT2I (Incidence rate per 1000 person-year, IR: 0.32; 95% confidence interval, CI 0.23-0.43) than in DPP4I (IR per 1000 person-year: 1.22; CI 1.03-1.42) users. Multivariable Cox regression found that SGLT2I use was associated with lower risks of gastric cancer (HR 0.30; 95% CI 0.19-0.48), PU, acute gastritis, non-acute gastritis, and GERD (p < 0.05) compared to DPP4I use. In the three-arm analysis, GLP1a use was associated with higher risks of gastric cancer and GERD compared to SGLT2I use.
CONCLUSIONS: The use of SGLT2I was associated with lower risks of new-onset gastric cancer, PU, acute gastritis, non-acute gastritis, and GERD after matching and adjustments compared to DPP4I use. SGLT2I use was associated with lower risks of GERD and gastric cancer compared to GLP1a use.
摘要：
目的：比较2型糖尿病（T2DM）暴露于钠-葡萄糖协同转运蛋白2抑制剂（SGLT2I）的患者胃癌和其他胃部疾病的风险。二肽基肽酶-4抑制剂(DPP4I)或胰高血糖素样肽-1受体激动剂(GLP1a)。
方法：这是一项以人群为基础的队列研究，对服用SGLT2I的T2DM患者进行前瞻性收集的数据，DPP4I或GLP1a于2015年1月1日至2020年12月31日从香港。结果是新发胃癌，消化性溃疡（PU），急性胃炎,非急性胃炎,胃食管反流病（GERD）。使用最近邻搜索进行倾向得分匹配(1:1)，并应用多变量Cox回归。SGLT2I之间的三臂比较，DPP4I和GLP1a使用倾向评分以治疗加权的逆概率进行。
结果：共纳入62,858例患者（中位年龄：62.2岁[SD：12.8]；55.93%男性；SGLT2I：n=23,442；DPP4I：n=39,416）。在匹配的队列中，SGLT2I的胃癌发病率较低(每1000人年发病率，IR:0.32;95%置信区间,CI0.23-0.43）比DPP4I（每1000人年IR：1.22；CI1.03-1.42）用户高。多变量Cox回归发现SGLT2I的使用与较低的胃癌风险相关（HR0.30;95％CI0.19-0.48），PU,急性胃炎,非急性胃炎,和GERD(p<0.05)相比DPP4I使用。在三臂分析中，与SGLT2I相比，GLP1a的使用与更高的胃癌和GERD风险相关。
结论：SGLT2I的使用与新发胃癌的风险降低相关，PU,急性胃炎,非急性胃炎,与GERD进行匹配和调整后相比DPP4I使用。与使用GLP1a相比，使用SGLT2I与GERD和胃癌的风险较低相关。
方法：这是一项以人群为基础的队列研究，对服用SGLT2I的T2DM患者进行前瞻性收集的数据，DPP4I或GLP1a于2015年1月1日至2020年12月31日从香港。结果是新发胃癌，消化性溃疡（PU），急性胃炎,非急性胃炎,胃食管反流病（GERD）。使用最近邻搜索进行倾向得分匹配(1:1)，并应用多变量Cox回归。SGLT2I之间的三臂比较，DPP4I和GLP1a使用倾向评分以治疗加权的逆概率进行。
结果：共纳入62,858例患者（中位年龄：62.2岁[SD：12.8]；55.93%男性；SGLT2I：n=23,442；DPP4I：n=39,416）。在匹配的队列中，SGLT2I的胃癌发病率较低(每1000人年发病率，IR:0.32;95%置信区间,CI0.23-0.43）比DPP4I（每1000人年IR：1.22；CI1.03-1.42）用户高。多变量Cox回归发现SGLT2I的使用与较低的胃癌风险相关（HR0.30;95％CI0.19-0.48），PU,急性胃炎,非急性胃炎,和GERD(p<0.05)相比DPP4I使用。在三臂分析中，与SGLT2I相比，GLP1a的使用与更高的胃癌和GERD风险相关。
结论：SGLT2I的使用与新发胃癌的风险降低相关，PU,急性胃炎,非急性胃炎,与GERD进行匹配和调整后相比DPP4I使用。与使用GLP1a相比，使用SGLT2I与GERD和胃癌的风险较低相关。
