Duration-dependent beneficial effects of metformin, sulfonylurea, and thiazolidinedione use on severe chronic obstructive pulmonary disease (COPD) exacerbation have been observed in patients with COPD and diabetes, according to study results published in Respiratory Research.
COPD is involved with systemic and pulmonary inflammation, which may be attenuated with antidiabetic agents exerting anti-inflammatory effects; however, real-world evidence is lacking regarding the effects of antidiabetic agents on COPD exacerbation. Therefore, researchers conducted a disease risk score (DRS)-matched nested case-control study to assess the association between each class of oral hypoglycemic agents (OHAs) and the risk of severe COPD exacerbation in COPD patients co-diagnosed with diabetes by analyzing the Taiwan National Health Insurance claims database between January 1, 2000, and December 31, 2015.
A total of 2700 cases of severe COPD exacerbation and 9272 randomly selected control individuals after DRS matching were analyzed. Current use of metformin vs other oral hypoglycemic agents was associated with a 15% reduced risk of severe COPD exacerbation, whereas the reduced risk was not observed with other types of antidiabetic agents. When considering the duration of antidiabetic medication therapy, current use of metformin for 91 to180 and 181 to365 days was associated with a 28% and 37% reduced risk of severe COPD exacerbation, respectively. Similarly, 91 to180 days of sulfonylurea therapy led to a 28% lower risk, and longer treatments consistently yielded lower risks between 24% and30%. Current use of thiazolidinediones for more than 181 days yielded an approximately 40% decreased risk.
“This large observational study of more than 23,000 COPD patients co-diagnosed with [diabetes] observed a duration-dependent beneficial effect of current use of metformin, sulfonylureas, and [thiazolidinediones], respectively, on severe COPD exacerbation,” the study authors concluded.
Wang M-T, Lai J-H, Huang Y-L, et al. Use of antidiabetic medications and risk of chronic obstructive pulmonary disease exacerbation requiring hospitalization: a disease risk score-matched nested case-control study. Respir Res. 2020;21(1):319. doi:10.1186/s12931-020-01547-1