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2016 ; 7
(3
): 439-54
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Systematic Literature Review of DPP-4 Inhibitors in Patients with Type 2 Diabetes
Mellitus and Renal Impairment
#MMPMID27502495
Thomas MC
; Paldánius PM
; Ayyagari R
; Ong SH
; Groop PH
Diabetes Ther
2016[Sep]; 7
(3
): 439-54
PMID27502495
show ga
INTRODUCTION: Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used in the
management of patients with type 2 diabetes mellitus (T2DM) and renal impairment
(RI). A systematic literature review was performed to compare the efficacy and
safety of DPP-4 inhibitors in patients with T2DM and RI. METHODS: We searched
EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials (cut-off,
June 2015) to identify ?12-week, randomized, placebo-controlled trials on DPP-4
inhibitors in ?50 patients with T2DM and RI. Outcomes of interest included change
in glycated hemoglobin (HbA1c), overall safety, and incidence of hypoglycemic
events (HEs). RESULTS: Seven trials of ?52-54 weeks duration were retrieved,
which included one study each on vildagliptin, saxagliptin, and sitagliptin, two
on linagliptin, and the remaining two were extension studies of vildagliptin and
saxagliptin. Majority of patients were on insulin at baseline (53-86%), except in
the sitagliptin study, where approximately 11% received insulin during the
placebo-controlled phase. After 52 weeks, vildagliptin and saxagliptin reduced
HbA1c levels by 0.6-0.7% (baseline 7.8-8.4%) versus placebo in the overall
population. HbA1c reductions were similar at weeks 12 and 52. In the 12-week,
placebo-controlled phase, sitagliptin and linagliptin reduced mean HbA1c by
approximately 0.4% (baseline 7.7-8.1%) versus placebo. Rates of HEs with DPP-4
inhibitors were not significantly different versus placebo in any study. Rates of
adverse events (AEs) and changes involving renal function were similar in the
active- and placebo-treated groups. CONCLUSION: These results suggest that DPP-4
inhibitors have the potential to improve glycemic control in patients with RI
without increasing the risk of HEs or overall AEs. FUNDING: Novartis Pharma AG.