Abstract P281: Pre-Stroke Use of Dipeptidyl Peptidase-4 Inhibitors in Elderly Patients May Reduce Neurological Severity at the Onset of Stroke: A Retrospective Cohort Study

Abstract

Introduction: Functional outcomes after acute stroke (AS) are related to the initial neurological severity. Therefore, neuroprotective agents to reduce initial brain damage at AS onset shows promise as a preventive approach. Dipeptidyl peptidase 4 inhibitors (DPP4i) have been reported to reduce stroke volume in mice. Therefore, DPP4i may exert neuroprotective effects on brain damage caused by AS. However, the association between pre-stroke use of DPP4i and neurological severity at the onset of AS has not been well studied. Hypothesis: Pre-stroke DPP4i use reduces neurological severity (NS) at the onset of AS. Methods: We conducted a retrospective cohort study involving patients admitted within 24 hours of AS onset between January 2013 and March 2019 with available pre-stroke medication information. We defined mild NS as a score of ≤5 points on the National Institutes of Health Stroke Scale. We used logistic regression analysis using variables for pre-stroke DPP4i initiation, calculated propensity scores for pre-stroke DPP4i use and implemented one-to-one propensity score matching (PSM). We compared the incidence of mild NS between the two groups. Results: Out of 4294 patients with AS, 3472 met the inclusion criteria. After PSM, we had 221 patients in each group. The median ages of DPP4i users and non-users were 79 and 78 years, respectively. Among the 221 DPP4i users and the 221 non-users, 140 (63.4%) and 121 (54.8%) patients had reduced NS, respectively (p=0.0659 by chi-square test, standardized difference=0.1756). The chi-square test did not show a significant difference in the matched cohort, but the standardized difference of 0.1 or more suggested that the two groups were not balanced on the incidence of mild NS. Conclusions: The pre-stroke use of DPP4i among elderly patients was associated with mild NS at AS onset, suggesting a potential neuroprotective effect of DPP4i on initial brain damage caused by AS. Further prospective studies with larger sample size are needed to verify the causal relationship between pre-stroke DPP4i use and NS at AS onset.