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Emerging role of dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes.

Richter B, Bandeira-Echtler E, Bergerhoff K, Lerch C - Vasc Health Risk Manag (2008)

Bottom Line: However, every new compound for T2DM has to prove long-term safety especially on cardiovascular outcomes.Systematic review and meta-analysis of the effects of sitagliptin and vildagliptin therapy on main efficacy parameters and safety.Long-term data on cardiovascular outcomes and safety are needed before widespread use of these new agents.

View Article: PubMed Central - PubMed

Affiliation: Cochrane Metabolic and Endocrine Disorders Group, Department of General Practice, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany. richterb@uni-duesseldorf.de

ABSTRACT

Background: In type 2 diabetes mellitus (T2DM) there is a progressive loss of beta-cell function. One new approach yielding promising results is the use of the orally active dipeptidyl peptidase-4 (DPP-4) inhibitors. However, every new compound for T2DM has to prove long-term safety especially on cardiovascular outcomes.

Objectives: Systematic review and meta-analysis of the effects of sitagliptin and vildagliptin therapy on main efficacy parameters and safety. SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Randomized controlled clinical studies of at least 12 weeks' duration in T2DM.

Results: DPP-4 inhibitors versus placebo showed glycosylated hemoglobin A1c (A1c) improvements of 0.7% versus placebo but not compared to monotherapy with other hypoglycemic agents (0.3% in favor of controls). The overall risk profile of DPP-4 inhibitors was low, however a 34% relative risk increase (95% confidence interval 10% to 64%, P = 0.004) was noted for all-cause infection associated with sitagliptin use. No data on immune function, health-related quality of life and diabetic complications could be extracted.

Conclusions: DPP-4 inhibitors have some theoretical advantages over existing therapies with oral antidiabetic compounds but should currently be restricted to individual patients. Long-term data on cardiovascular outcomes and safety are needed before widespread use of these new agents.

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Related in: MedlinePlus

Mean body weight changes [kg] in vildagliptin randomised controlled trials. Weighted mean differences by means of random-effects model (inverse varicance (IV) method) showing 95% confidence intervals (CI) for single studies and pooled effect sizes. I2 describes the percentage of total variation across studies due to heterogeneity.
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f3-vhrm-4-0753: Mean body weight changes [kg] in vildagliptin randomised controlled trials. Weighted mean differences by means of random-effects model (inverse varicance (IV) method) showing 95% confidence intervals (CI) for single studies and pooled effect sizes. I2 describes the percentage of total variation across studies due to heterogeneity.

Mentions: Figures 1.3.1 and 2.3.1 show the effects of DPP-4 inhibition on body weight. The first panel provides an overview of all study arms for illustrating purposes only.


Emerging role of dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes.

Richter B, Bandeira-Echtler E, Bergerhoff K, Lerch C - Vasc Health Risk Manag (2008)

Mean body weight changes [kg] in vildagliptin randomised controlled trials. Weighted mean differences by means of random-effects model (inverse varicance (IV) method) showing 95% confidence intervals (CI) for single studies and pooled effect sizes. I2 describes the percentage of total variation across studies due to heterogeneity.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2597770&req=5

f3-vhrm-4-0753: Mean body weight changes [kg] in vildagliptin randomised controlled trials. Weighted mean differences by means of random-effects model (inverse varicance (IV) method) showing 95% confidence intervals (CI) for single studies and pooled effect sizes. I2 describes the percentage of total variation across studies due to heterogeneity.
Mentions: Figures 1.3.1 and 2.3.1 show the effects of DPP-4 inhibition on body weight. The first panel provides an overview of all study arms for illustrating purposes only.

Bottom Line: However, every new compound for T2DM has to prove long-term safety especially on cardiovascular outcomes.Systematic review and meta-analysis of the effects of sitagliptin and vildagliptin therapy on main efficacy parameters and safety.Long-term data on cardiovascular outcomes and safety are needed before widespread use of these new agents.

View Article: PubMed Central - PubMed

Affiliation: Cochrane Metabolic and Endocrine Disorders Group, Department of General Practice, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany. richterb@uni-duesseldorf.de

ABSTRACT

Background: In type 2 diabetes mellitus (T2DM) there is a progressive loss of beta-cell function. One new approach yielding promising results is the use of the orally active dipeptidyl peptidase-4 (DPP-4) inhibitors. However, every new compound for T2DM has to prove long-term safety especially on cardiovascular outcomes.

Objectives: Systematic review and meta-analysis of the effects of sitagliptin and vildagliptin therapy on main efficacy parameters and safety. SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Randomized controlled clinical studies of at least 12 weeks' duration in T2DM.

Results: DPP-4 inhibitors versus placebo showed glycosylated hemoglobin A1c (A1c) improvements of 0.7% versus placebo but not compared to monotherapy with other hypoglycemic agents (0.3% in favor of controls). The overall risk profile of DPP-4 inhibitors was low, however a 34% relative risk increase (95% confidence interval 10% to 64%, P = 0.004) was noted for all-cause infection associated with sitagliptin use. No data on immune function, health-related quality of life and diabetic complications could be extracted.

Conclusions: DPP-4 inhibitors have some theoretical advantages over existing therapies with oral antidiabetic compounds but should currently be restricted to individual patients. Long-term data on cardiovascular outcomes and safety are needed before widespread use of these new agents.

Show MeSH
Related in: MedlinePlus