Effects of a DPP-4 inhibitor and RAS blockade on clinical outcomes of patients with diabetes and COVID-19

ABSTRACT

BackgroundDipeptidyl peptidase-4 inhibitor (DPP-4i) and renin-angiotensin system (RAS) blockade are reported to affect the clinical course of coronavirus disease 2019 (COVID-19) in patients with diabetes mellitus (DM). However, the effectiveness of these drugs in large populations is unclear. Subjects and MethodsAs of May 2020, data analysis was conducted on all subjects who could confirm their history of claims related to COVID-19 in the National Health Review and Assessment Service database in Korea. Using the COVID-19 and claims data of the past 5 years, we compared the short-term prognosis of COVID-19 infection according to the use of DPP-4i and RAS blockade. ResultsTotally, data of 67850 subjects were accessible. Of these, 5080 were confirmed COVID-19. Among these, 832 subjects with DM were selected for analysis in this study. Among the subjects, 263 (31.6%) and 327 (39.3%) were DPP-4i and RAS blockade users, respectively. Thirty-four subjects (4.09%) received intensive care or died. The adjusted odds ratio for severe treatment among DPP-4i users was 0.362 [95% confidence interval (CI), 0.135-0.971], and that for RAS blockade users was 0.599 (95% CI, 0.251-1.431). No synergy was observed for subjects using both drugs. ConclusionThis population-based study suggests that DPP-4i is significantly associated with a better clinical outcome of patients with COVID-19. However, the effect of RAS blockade is not significant.