MORGANTOWN, WV—Dipeptidyl peptidase (DPP)-4 inhibitors appear to be associated with joint pain in older veterans who receive care at the VHA but also are Medicare beneficiaries, according to a new study.

The report in American Health Drug Benefits pointed out that DPP-4 inhibitors are increasingly being added to the diabetes treatment algorithm. Yet, according to researchers from West Virginia University and the VA New Jersey Healthcare System in East Orange, that possible side effect has been the focus of few published studies on the Type 2 diabetes drug. “To our knowledge, no population-based studies in the United States have studied this association,” the authors wrote.

To remedy that, the study team sought to evaluate the association between a new prescription of DPP-4 inhibitors and joint pain within one year among older veterans with diabetes.

To do that, researchers conducted a retrospective cohort study of 134,488 veterans 66 and older who were dually enrolled in Medicare and the VHA. The study used data from linked Medicare claims and VHA electronic health records from 2008 to 2010.

To identify diabetes during the baseline and joint pain during the follow-up period, the authors used the International Classification of Diseases, Ninth Revision codes. Filled prescriptions for DPP-4 inhibitors during the baseline period were pinpointed from Medicare Part D and VHA pharmacy records.

Results indicated that about 8.4% of the 134,488 study patients received at least one prescription for DPP-4 inhibitors, and 11.7% were diagnosed with joint pain during the follow-up period.

In an unadjusted analysis, the researchers found significant differences in joint pain by DPP-4 inhibitor status (12.9% among users vs 11.6% among nonusers; P <.0001). In a fully adjusted model, they concluded that patients having a DPP-4 inhibitor prescription had higher odds of joint pain (adjusted odds ratio, 1.17; 95% confidence interval, 1.10-1.24) compared with no prescription for a DPP-4 inhibitor.

“In a cohort of older veterans who did not have documented joint pain at baseline, a prescription for DPP-4 inhibitors was significantly associated with a newly documented joint pain,” the researchers concluded.

  1. Rai P, Dwibedi N, Rowneki M, Helmer DA, Sambamoorthi U. Dipeptidyl Peptidase-4 Inhibitors and Joint Pain: A Retrospective Cohort Study of Older Veterans with Type 2 Diabetes Mellitus. Am Health Drug Benefits. 2019;12(5):223–231.