SUN-584 - Association between DPP-4 inhibitor use and Herpes zoster risk in Older Adults With Type 2 Diabestes

Herpes zoster (HZ) is an important infectious complication in older adults with diabetes. However, evidence on whether HZ risk differs according to antidiabetic drug class in real-world practice remains limited. This study evaluated the association between dipeptidyl peptidase-4 inhibitor (DPP-4i) use and HZ risk in older patients with type 2 diabetes (T2DM).
We conducted a retrospective cohort study using the National Health Insurance Service-Elderly Cohort from 2002 to 2013. Among 220,811 patients with T2DM after excluding those with type 1 diabetes, 68,224 patients who used DPP-4i or metformin were identified. After 1:1 propensity score matching, 14,379 patients were included in each group (DPP-4 inhibitor and metformin).
Among the matched cohort, 6,730 patients developed HZ. The mean age was 69.91 ± 5.58 years, and 41.15% of patients were male and 58.85% were female. DPP-4i use was significantly associated with a higher risk of HZ compared with metformin use (adjusted odds ratio [aOR], 1.18; 95% confidence interval [CI], 1.11-1.25). Notably, immune-compromised conditions and immunomodulatory medications showed strong associations with HZ. HIV-related opportunistic infection was independently associated with increased HZ risk (aOR, 1.40; 95% CI, 1.22-1.60). Among concomitant medications, systemic steroid use was one of the most prominent risk factors (aOR, 1.40; 95% CI, 1.29-1.52), and hydroxychloroquine use was also associated with increased risk (aOR, 1.87; 95% CI, 1.00-3.49). Methotrexate showed a high crude association that was attenuated after adjustment (OR, 2.61; 95% CI, 1.38-4.95; aOR, 1.73; 95% CI, 0.89-3.37). In contrast, sulfonylurea use was associated with a lower risk of HZ (aOR, 0.89; 95% CI, 0.82-0.96).
In older adults with T2DM, DPP-4i use was associated with a higher risk of HZ than metformin use. The increased risk observed with immune-compromised states and immunomodulatory therapies, particularly systemic steroids, suggests that host immune status should be carefully considered when selecting glucose-lowering therapy in elderly patients.

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