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DPP-4 inhibitors and cardiovascular outcomes

Incretin-based therapy has featured prominently in the medical media in recent months. Newly published studies on two agents in the dipeptidyl peptidase-4 (DPP-4) inhibitor class of drugs – alogliptin and saxagliptin – give us insights into the safety profiles of these agents.

by Colin Kenny, GP, Dromore, County Down

Two recently published clinical trials provided long-term data on dipeptidyl peptidase-4 (DPP-4) inhibitors. They were principally about cardiovascular (CV) risk in diabetes. The EXAMINE study assessed alogliptin, just granted marketing authorisation in Europe, while the SAVOR–TIMI 53 study assessed saxagliptin, which has been available for several years. The SAVOR-TIMI 53 study was larger, with 16,492 patients, while the EXAMINE study recruited 5380 very high-risk individuals. Both studies were performed primarily to establish whether these drugs were non-inferior to placebo in terms of major CV outcomes when added on to existing antidiabetes and CV therapies.

CV non-inferiority was established in both trials. Another key finding of the studies was that there was no excess pancreatitis or pancreatic cancer in the active treatment group. Both investigations showed a signal for heart failure, which will need more study. Cardiovascular risk still needs to be treated by the traditional methods of blood pressure and lipid lowering, as well as smoking cessation.

To access the EXAMINE study publication, click here (link to external website)

To access the SAVOR–TIMI 53 study publication, click here (link to external website)

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