PDB11 - Concomitant use of Repaglinide and Clopidogrel And Risk Of Hypoglycemia: A Population-Based Nested Case-Control Study

Abstract

A small trial showed a decreased glucose level of healthy subjects induced by concomitant use of clopidogrel and repaglinide. However, evidence of the link between the hypoglycemic risk in diabetic patients and this potential drug interaction remains lacking. The goal of this research is to investigate whether concomitant use of repaglinide and clopidogrel is associated with an increased risk of hypoglycemia. This was a nested case-control study using the nationwide claims database in Taiwan. Diabetic patients who ever treated with repaglinide or nateglinide were included in this study (n=110,654). Cases were defined as hospital admissions or emergency room visits due to hypoglycemia. Concomitant use of repaglinide and clopidogrel within 3 days before the hypoglycemic event was the exposure of interest. For each case, up to four controls were randomly selected and matched by age, sex, type of glinide exposure (repaglinide or nateglinde) and the duration of follow-up. The adjusted results were generated by conditional logistic regressions. A total of 1,014 cases and 3,600 matched controls were identified. Concomitant use of repaglinide and clopidogrel was associated with an increased risk of hypoglycemia compared to repaglinide alone (adjusted odds ratio [AOR]: 2.280, 95% confidence interval [Cl]: 1.504, 3.457). No significant increase in the hypoglycemic risk was found in the two pairs of drug concomitants for negative controls: the synchronous use of nateglinide and clopidogrel (AOR: 1.062, 95% Cl: 0.021, 54.526) and the concurrent use of repaglinide and aspirin (without clopidogrel use) (AOR: 1.170, 95% Cl: 0.894, 1.533). Our study suggested that a clinically significant drug-interaction between clopidogrel and repaglinide might exist and could cause increased risk for hypoglycemic events.