Gliptin Safety a 'Good Thing'
Gliptin Safety a 'Good Thing'
In the EXAMINE trial, alogliptin was compared with placebo and very similar results were seen. As I mentioned, these were sicker patients who had recently had a cardiovascular event, a myocardial infarction, or unstable angina. The study did not show the difference in terms of rates of CHF, nor did it find a difference in terms of rates of hypoglycemia. In the EXAMINE trial, however, rates of insulin use were slightly lower, so it is unclear what the real differences were in terms of hypoglycemia. Suffice it to say, when you have a patient who is on a sulfonylurea agent or insulin and you add in a DPP-4 inhibitor, be careful to reduce the dose of the drug that can cause the hypoglycemia.
Finally, in terms of rates of pancreatitis or pancreatic cancer, the studies found no differences in the groups. The DPP-4 inhibitor did not increase the risk for pancreatitis or pancreatic cancer in these trials.
In conclusion, these 2 large cardiovascular outcomes studies found no differences between the DPP-4 inhibitors and placebo, in terms of primary cardiovascular outcomes. Of concern is the increased risk for CHF seen in the saxagliptin-treated patients. Data from the SAVOR trial also suggests that you must remember to appropriately adjust the dose of insulin or a sulfonylurea agent when you add in a DPP-4 inhibitor.
I am Dr. Anne Peters for Medscape.
The EXAMINE Trial
In the EXAMINE trial, alogliptin was compared with placebo and very similar results were seen. As I mentioned, these were sicker patients who had recently had a cardiovascular event, a myocardial infarction, or unstable angina. The study did not show the difference in terms of rates of CHF, nor did it find a difference in terms of rates of hypoglycemia. In the EXAMINE trial, however, rates of insulin use were slightly lower, so it is unclear what the real differences were in terms of hypoglycemia. Suffice it to say, when you have a patient who is on a sulfonylurea agent or insulin and you add in a DPP-4 inhibitor, be careful to reduce the dose of the drug that can cause the hypoglycemia.
Finally, in terms of rates of pancreatitis or pancreatic cancer, the studies found no differences in the groups. The DPP-4 inhibitor did not increase the risk for pancreatitis or pancreatic cancer in these trials.
In conclusion, these 2 large cardiovascular outcomes studies found no differences between the DPP-4 inhibitors and placebo, in terms of primary cardiovascular outcomes. Of concern is the increased risk for CHF seen in the saxagliptin-treated patients. Data from the SAVOR trial also suggests that you must remember to appropriately adjust the dose of insulin or a sulfonylurea agent when you add in a DPP-4 inhibitor.
I am Dr. Anne Peters for Medscape.