Glucagon-Like Peptide-1 Receptor Agonists vs Dipeptidyl Peptidase-4 Inhibitor Use on Risk of Asthma Exacerbation Among Diabetic Patients with Co-Morbid Asthma in Hong Kong.
Co-existing asthma and diabetes mellitus (DM) are common, and there has been a debate on whether glucagon-like peptide-1 (GLP-1)-based therapies, such as GLP-1 receptor agonists (GLP-1RA) and inhibitors of dipeptidyl peptidase-4 (DPP-4i), confer benefits in these patients due to their anti-inflammatory effects in chronic inflammatory diseases.
A territory-wide retrospective cohort study was conducted in Hong Kong among adult patients with co-existing asthma and DM to examine the impact of add-on GLP-1RA or DPP-4i on asthma exacerbations, ranging from mild exacerbations managed in outpatient settings to severe exacerbations requiring hospitalization. Adult patients were prescribed DPP-4i or GLP-1RA in year 2018 and for at least 6 months in Hospital Authority of Hong Kong were included. These patients were followed till 31st December 31, 2023. Propensity score matching was performed using optimal full matching, which is a sub-classification-based approach in which treated and control subjects are assigned to matched subclasses.
A total of 3295 patients with both asthma and DM, 3193 treated with DPP-4i and 102 treated with GLP-1RA, were included in the study. There were 1191 (36.1%) male patients with a mean age of 68.0 ± 14.2 years. There were 2531 (76.8%) patients with moderate-to-severe asthma according to Global Initiative for Asthma (GINA) Steps 3 to 5. GLP-1RA-treated patients had significantly lower risks of hospitalized asthma exacerbation (Average Treatment Effect on the Treated (ATT) Mean Ratio of 0.513, p < 0.001), ad hoc outpatient visits with OCS (ATT Mean Ratio of 0.343, p = 0.005), emergency visits (ATT Mean Ratio of 0.378, p = 0.009), and all asthma exacerbations (ATT Mean Ratio of 0.419, p < 0.001) compared with the DPP-4i group.
GLP-1RA, compared with DPP-4i, as an add-on treatment for patients with co-existing DM and asthma was associated with a lower risk of asthma exacerbation. The use of GLP-1RA among diabetic patients with comorbid asthma may be considered though validation in clinical trials is needed.
A territory-wide retrospective cohort study was conducted in Hong Kong among adult patients with co-existing asthma and DM to examine the impact of add-on GLP-1RA or DPP-4i on asthma exacerbations, ranging from mild exacerbations managed in outpatient settings to severe exacerbations requiring hospitalization. Adult patients were prescribed DPP-4i or GLP-1RA in year 2018 and for at least 6 months in Hospital Authority of Hong Kong were included. These patients were followed till 31st December 31, 2023. Propensity score matching was performed using optimal full matching, which is a sub-classification-based approach in which treated and control subjects are assigned to matched subclasses.
A total of 3295 patients with both asthma and DM, 3193 treated with DPP-4i and 102 treated with GLP-1RA, were included in the study. There were 1191 (36.1%) male patients with a mean age of 68.0 ± 14.2 years. There were 2531 (76.8%) patients with moderate-to-severe asthma according to Global Initiative for Asthma (GINA) Steps 3 to 5. GLP-1RA-treated patients had significantly lower risks of hospitalized asthma exacerbation (Average Treatment Effect on the Treated (ATT) Mean Ratio of 0.513, p < 0.001), ad hoc outpatient visits with OCS (ATT Mean Ratio of 0.343, p = 0.005), emergency visits (ATT Mean Ratio of 0.378, p = 0.009), and all asthma exacerbations (ATT Mean Ratio of 0.419, p < 0.001) compared with the DPP-4i group.
GLP-1RA, compared with DPP-4i, as an add-on treatment for patients with co-existing DM and asthma was associated with a lower risk of asthma exacerbation. The use of GLP-1RA among diabetic patients with comorbid asthma may be considered though validation in clinical trials is needed.