The effect of DPP-4 inhibitors on asthma control: an administrative database study to evaluate a potential pathophysiological relationship

Gene Colice, David Price, Maria Gerhardsson de Verdier, Karma Rabon-Stith, Christopher Ambrose, Katherine Cappell, Debra E. Irwin, Paul Juneau, Anna Vlahiotis, Respiratory Effectiveness Group (REG)

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Rationale: DPP-4 may regulate immunological pathways implicated in asthma. Assessing whether DPP-4 inhibitor (DPP-4i) use might affect asthma control is clinically important because DPP-4i use in type 2 diabetes mellitus management (T2DM) is increasing. This study evaluated associations between DPP-4i use and asthma control.
Methods: This was a retrospective, observational, matched cohort study using administrative claims in the MarketScan® Commercial Claims and Encounters (Commercial) and Medicare Supplemental and Coordination of Benefits (Medicare Supplemental) databases. Adult asthma patients initiating an oral DPP-4i or a non-DPP-4i between November 1, 2006 and March 31, 2014 were included. Patients were followed for asthma-related outcomes for 12 months after initiation of the antidiabetes medication. Outcomes included risk-domain asthma control (RDAC), defined as no asthma hospitalizations, no lower respiratory tract infections, and no oral corticosteroid (OCS) prescriptions; overall asthma control (RDAC criteria plus limited short-acting beta agonist use); treatment stability (RDAC criteria plus no increase of ≥50% in inhaled corticosteroid dose or addition of other asthma therapy); and severe asthma exacerbation rates (asthma-related hospitalizations, emergency room visits, or acute treatments with OCS). Comparisons were made between two matched cohorts (DPP-4i vs. non-DPP-4i initiators) using multivariable logistic regression and generalized linear modeling. Covariates included baseline demographic and clinical characteristics related to asthma and T2DM.
Results: The adjusted odds of achieving RDAC (odds ratio [OR]: 1.05; 95% CI: 0.964 to 1.147), overall asthma control (OR: 1.04; 95% CI: 0.956 to 1.135), and treatment stability (OR: 1.04; 95% CI: 0.949 to 1.115) did not differ between the DPP-4i and non-DPP-4i cohorts. A difference was not found between cohorts in severe asthma exacerbation rates during the 12 months following initiation of antidiabetes treatment (mean = 0.32 vs. 0.34 exacerbations per subject-year, respectively; p=0.064).
Conclusion: Asthma control was similar between patients initiating DPP-4i and non-DPP-4i antidiabetes medications, suggesting no association between DPP-4i use and asthma control.
Original languageEnglish
Pages (from-to)231-240
Number of pages10
JournalPragmatic and Observational Research
Issue number8
Publication statusPublished - 1 Dec 2017

Bibliographical note

The authors acknowledge Koustubh Ranade (MedImmune, Gaithersburg, MD, USA) and Stephen Johnston, a member of the steering committee who was employed by Truven Health Analytics at the time the study was conducted, for their contributions to this study . Truven Health Analytics, an IBM Company, received funding from AstraZeneca in relation to this study.
This work was previously presented as a poster at the annual international conference of the American Thoracic Society, May 19–24, 2017, Washington, DC (Colice G, et al. The Effect of Dipeptidyl-Peptidase-4 Inhibitors on Asthma
Control: An Administrative Database Study to Evaluate a Potential Pathophysiological Relationship. Am J Respir Crit Care Med. 2017;195:A3050).


  • asthma control
  • DPP-4i
  • type 2 diabetes


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