1567P - The effect of SGLT2i and DPP4i on new-onset gastric cancer and gastric diseases in type 2 diabetes mellitus: A population-based cohort study

Background

The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) and dipeptidyl peptidase-4 inhibitors (DPP4I) on the risk of gastric cancer remains unknown. This study aims to compare the effects of SGLT2I and DPP4I on gastric cancer and other gastric diseases.

Methods

This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus (T2DM) on either SGLT2I or DPP4I between 1^st January 2015 and 31^st December 2020 in Hong Kong. The primary outcome was new-onset gastric cancer, peptic ulcer (PU), acute gastritis, non-acute gastritis, and gastroesophageal reflux disease (GERD). Propensity score matching (1:1 ratio) using the nearest neighbour search was performed. Univariable and multivariable Cox regression was applied to identify the associations.

Results

This cohort included 62858 T2DM patients (median age: 62.2 years old [SD: 12.8]; 55.93% males). 23442 patients used SGLT2I, and 39416 patients used DPP4I. After matching, the incidence of gastric cancer (incidence rate ratio, IRR: 0.26; 95% confidence interval, CI: 0.18-0.37) was significantly lower in SGLT2I users than in DPP4I. SGLT2I was associated with lower risks of gastric cancer (Hazard ratio, HR: 0.30; 95% CI: 0.19-0.48). SGLT2I was also associated with lower risks of PU (HR: 0.66; 95% CI: 0.47-0.91), acute gastritis (HR: 0.31; 95% CI: 0.20-0.48), non-acute gastritis (HR: 0.35; 95% CI: 0.25-0.49), and GERD (HR: 0.62; 95% CI: 0.50-0.76) compared to DPP4I after adjustments. In the subgroup analysis, the results remained consistent across different age groups and genders. SGLT2I was associated with lower risks of gastric cancer amongst patients without prior H. pylori infection (HR: 0.26; 95% CI: 0.18-0.37) but not those with prior infection (HR: 0.28; 95% CI: 0.08-1.01). The results were consistent in the competing risk models and the different matching approaches in the sensitivity analysis.

Conclusions

SGLT2I was associated with lower risks of new-onset gastric cancer than DPP4I. SGLT2I was also associated with lower risks of PU, acute gastritis, non-acute gastritis, and GERD after matching and adjustments compared to DPP4I.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Cardiovascular Analytics Group.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.