Risk of arthralgia due to dipeptidyl peptidase-4 inhibitors: a Meta-analysis

Objective To evaluate the risk of arthralgia due to dipeptidyl peptidase-4 (DPP-4) inhibitors. Methods The documents involving arthralgia due to DPP-4 inhibitors ending in February 2016 were searched from correlative data base and online library. DPP-4 inhibitors was used in the test group while placebo was used in the control group. The relevant data were collected from enrolled documents and the quality of RCTs was assessed. The software Review Manager 5.3 was used for Meta-analysis and the results were expressed in RR and 95%CI. Results A total of 22 RCTs were enrolled into the Meta-analysis and 9 927 patients [6 760 cases in the test group (T) and 3 167 cases in the control group(T)] were treated 12 to 206 weeks. The number of patients who were enrolled into the study on sitagliptin, saxagliptin, vildagliptin, linagliptin, and alogliptin were 954 (T: 545, C: 409), 4 246 (T: 2 923, C: 1 323) , 899 (T: 528, C: 371), 2 624 (T: 1 893, C: 731), and 1 204 (T: 871, C: 333), respectively. The results of quality evaluation to all literatures showed 13 for Grade A and 8 for Grade B. The results of Meta analysis showed that the risk of arthralgia induced by saxagliptin and vildagliptin was higher than that by placebo (RR=1.35, 95%CI: 1.01-1.81, P=0.04 and RR=2.80, 95%CI: 1.29-6.08, P 0.05). Conclusions Saxagliptin and vildagliptin may increase the risk of arthralgia. The patients with type 2 diabetes and joint disease should choose sitagliptin, linagliptin or alogliptin when they were using DPP-4 inhibitors. Key words: Dipeptidyl-peptidase Ⅳ inhibitors; Arthralgia; Meta-analysis