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Liu H, Yu S, Li X, Wang X, Qi D, Pan F, Chai X, Wang Q, Pan Y, Zhang L, Liu Y. Integration of Deep Learning and Sequential Metabolism to Rapidly Screen Dipeptidyl Peptidase (DPP)-IV Inhibitors from Gardenia jasminoides Ellis. Molecules 2023; 28:7381. [PMID: 37959800 PMCID: PMC10649927 DOI: 10.3390/molecules28217381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Traditional Chinese medicine (TCM) possesses unique advantages in the management of blood glucose and lipids. However, there is still a significant gap in the exploration of its pharmacologically active components. Integrated strategies encompassing deep-learning prediction models and active validation based on absorbable ingredients can greatly improve the identification rate and screening efficiency in TCM. In this study, the affinity prediction of 11,549 compounds from the traditional Chinese medicine system's pharmacology database (TCMSP) with dipeptidyl peptidase-IV (DPP-IV) based on a deep-learning model was firstly conducted. With the results, Gardenia jasminoides Ellis (GJE), a food medicine with homologous properties, was selected as a model drug. The absorbed components of GJE were subsequently identified through in vivo intestinal perfusion and oral administration. As a result, a total of 38 prototypical absorbed components of GJE were identified. These components were analyzed to determine their absorption patterns after intestinal, hepatic, and systemic metabolism. Virtual docking and DPP-IV enzyme activity experiments were further conducted to validate the inhibitory effects and potential binding sites of the common constituents of deep learning and sequential metabolism. The results showed a significant DPP-IV inhibitory activity (IC50 53 ± 0.63 μg/mL) of the iridoid glycosides' potent fractions, which is a novel finding. Genipin 1-gentiobioside was screened as a promising new DPP-IV inhibitor in GJE. These findings highlight the potential of this innovative approach for the rapid screening of active ingredients in TCM and provide insights into the molecular mechanisms underlying the anti-diabetic activity of GJE.
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Affiliation(s)
- Huining Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Shuang Yu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Xueyan Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Xinyu Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Dongying Qi
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Fulu Pan
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Xiaoyu Chai
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Qianqian Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
| | - Yanli Pan
- Institute of Information on Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Lei Zhang
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing 100191, China
| | - Yang Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China; (H.L.); (S.Y.); (X.L.); (X.W.); (D.Q.); (F.P.); (X.C.); (Q.W.)
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Liu W, Wang X, Yang W, Li X, Qi D, Chen H, Liu H, Yu S, Pan Y, Liu Y, Wang G. Identification, Screening, and Comprehensive Evaluation of Novel DPP-IV Inhibitory Peptides from the Tilapia Skin Gelatin Hydrolysate Produced Using Ginger Protease. Biomolecules 2022; 12:biom12121866. [PMID: 36551294 PMCID: PMC9775409 DOI: 10.3390/biom12121866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Inhibition of dipeptidyl peptidase-IV (DPP-IV) is an effective therapy for treating type II diabetes (T2D) that has been widely applied in clinical practice. We aimed to evaluate the DPP-IV inhibitory properties of ginger protease hydrolysate (GPH) and propose a comprehensive approach to screen and evaluate DPP-IV inhibitors. METHODS We evaluated the in vitro inhibitory properties of fish skin gelatin hydrolysates produced by five proteases, namely, neutral protease, alkaline protease, bromelain, papain, and ginger protease, toward DPP-IV. We screened the most potent DPP-IV inhibitory peptide (DIP) using liquid chromatography-tandem mass spectrometry (LC-MS/MS) coupled with in silico analysis. Next, surface plasmon resonance (SPR) technology was innovatively introduced to explore the interactions between DPP-IV and DIP, as well as the IC50. Furthermore, we performed oral administration of DIP in rats to study its in vivo absorption. RESULTS GPH displayed the highest degree of hydrolysis (20.37%) and DPP-IV inhibitory activity (65.18%). A total of 292 peptides from the GPH were identified using LC-MS/MS combined with de novo sequencing. Gly-Pro-Hyp-Gly-Pro-Pro-Gly-Pro-Gly-Pro (GPXGPPGPGP) was identified as the most potent DPP-IV inhibitory peptide after in silico screening (Peptide Ranker and molecular docking). Then, the in vitro study revealed that GPXGPPGPGP had a high inhibitory effect on DPP-IV (IC50: 1012.3 ± 23.3 μM) and exhibited fast kinetics with rapid binding and dissociation with DPP-IV. In vivo analysis indicated that GPXGPPGPGP was not absorbed intact but partially, in the form of dipeptides and tripeptides. CONCLUSION Overall, the results suggested that GPH would be a natural functional food for treating T2D and provided new ideas for searching and evaluating potential antidiabetic compounds. The obtained GPXGPPGPGP can be structurally optimized for in-depth evaluation in animal and cellular experiments.
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Affiliation(s)
- Wei Liu
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Xinyu Wang
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Wenning Yang
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Xueyan Li
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Dongying Qi
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Hongjiao Chen
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Huining Liu
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Shuang Yu
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
| | - Yanli Pan
- Institute of Information on Traditional Chinese Medicine China Academy of Chinese Medical Sciences, Beijing 100700, China
- Correspondence: (Y.P.); (Y.L.); (G.W.)
| | - Yang Liu
- Department of Chemistry of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China
- Correspondence: (Y.P.); (Y.L.); (G.W.)
| | - Guopeng Wang
- Zhongcai Health (Beijing) Biological Technology Development Co., Ltd., Beijing 101500, China
- Correspondence: (Y.P.); (Y.L.); (G.W.)
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Elhini SH, Hussien AK, Omran AAE, Elsayed AA, Saeed H. Efficacy and safety profile of Sitagliptin, vildagliptin, and metformin in newly diagnosed type 2 diabetic subjects. Clin Exp Pharmacol Physiol 2021; 48:1589-1602. [PMID: 34333803 DOI: 10.1111/1440-1681.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Abstract
Type-2 diabetes mellitus is a chronic and progressive disease that requires long-term management. Thus, Dipeptidyl peptidase-4 inhibitors (DPP-4) need more investigations about their efficacy and safety profile as there is still no evidence of whether DPP-4 inhibitors can be used as 1st line option for type2 diabetes drug naïve patients. In this randomized case-controlled study, 60 drug-naïve type 2 diabetic subjects were randomized into 3 groups, each group comprising 20 subjects. Group 1 was given sitagliptin 100 mg once daily, Group 2 was given vildagliptin 50 mg twice daily, and Group 3 served as the control group and was given Metformin 1gm twice daily. Efficacy endpoints included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hr postprandial plasma glucose (PPG), and the secondary endpoints were related to safety profile were the assessment of liver and kidney function tests and complete blood count (CBC). All treatment regimens had comparable efficacy and safety profiles with the non-significant relative superiority of vildagliptin in lowering HbA1c more than sitagliptin but significant (p=0.011) regarding FPG reduction, vildagliptin significantly decreased HbA1c by -1.02 % (P< 0.001), sitagliptin significantly decreased HbA1c by -0.96% (P< 0.001), and control significantly decreased HbA1c by -0.90% (P< 0.001) compared with baseline. The studied drugs showed moderate efficacy in lowering HbA1c levels with the non-significant relative higher efficacy of DPP-4 inhibitors. DPP-4 inhibitors and metformin showed favorable effects on improving metabolic syndrome by decreasing blood pressure, serum triglycerides (TG), low-density lipoprotein (LDL), total cholesterol, and increasing high-density lipoprotein (HDL), plus their positive impacts on weight. As a final conclusion, the three medications are highly comparable.
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Affiliation(s)
- Sahar Hossam Elhini
- Diabetes and Endocrinology, Faculty of Medicine, Minya University, Minya, 61111, Egypt
| | - Amal Kmal Hussien
- Pharmaceutics Department, Faculty of Pharmacy, Minya University, Minya, 61111, Egypt
| | | | - Asmaa A Elsayed
- Clinical Pharmacy Department, Faculty of Pharmacy, Minya University, Minya, 61111, Egypt
| | - Haitham Saeed
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, 62814, Egypt
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Mohsen M, Elberry AA, Mohamed Rabea A, Abdelrahim MEA, Hussein RRS. Saxagliptin and vildagliptin lowered albuminuria in patients with diabetes and hypertension independent on glycaemic control. Int J Clin Pract 2021; 75:e13769. [PMID: 33068301 DOI: 10.1111/ijcp.13769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/20/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preclinical data illustrated that the dipeptidyl peptidase-4(DPP-4) inhibitors did lower urinary albumin excretion in diabetes-induced rats. We evaluated the effects of saxagliptin and vildagliptin on albuminuria in patients with diabetic nephropathy on top of the renin-angiotensin-aldosterone system (RAAS) blockade therapy. METHODS This study included 120 patients with type 2 diabetes (T2D), hypertension, and prevalent albuminuria [defined as urine albumin-to-creatinine ratio (UACR) 30-3000mg/g creatinine] on a stable dose of olmesartan as a standard RAAS blocker for diabetic nephropathy. Patients were assigned to receive either of saxagliptin 5mg/day (n = 40), vildagliptin 100mg/day (n = 40), or traditional antidiabetic therapy as control patients (n = 40) for 12 weeks. RESULTS Each of saxagliptin and vildagliptin significantly reduced albuminuria after 12 weeks, with mean percentage changes (%) of -57.9% [95% confidence interval (CI) -66.1 to -49.8], and -55.2% (95% CI -64.9 to -45.4); P < .001, respectively, compared with the control group. Significantly, saxagliptin shifted higher proportions of patients towards lower albuminuria categories (P < .001) compared with vildagliptin despite a similar UACR rate of changes. Results of binary logistic models confirmed that the change in UACR because saxagliptin was independent of changes in systolic blood pressure (SBP), glycated hemoglobin (HbA1c ), estimated glomerular filtration rate (eGFR), or body weight (overall regression: P = .002, R2 = 0.398) vs control. Likewise, vildagliptin reduced UACR independently on other confounders (overall regression: P = .002, R2 = 0.388). Furthermore, no significant correlation was observed between the change in UACR and changes in HbA1c, SBP or eGFR with either saxagliptin or vildagliptin (Pearson coefficients: 0.203, 0.143, -0.190; P > .05, and 0.003, 0.241, 0.019; P > .05, respectively). CONCLUSIONS DPP-4 inhibitors, saxagliptin, and vildagliptin, resulted in substantial reductions in albuminuria in patients with T2D and hypertension on top of RAAS blockade after short term therapy independently on glycaemic or hemodynamic changes. Saxagliptin was superior to vildagliptin in albuminuria-categorical shifting.
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Affiliation(s)
- Marwa Mohsen
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed A Elberry
- Clinical Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Alaa Mohamed Rabea
- Internal Medicine and Nephrology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Raghda R S Hussein
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Abdelrahman AE, Maher HM, Alzoman NZ. HPTLC Method for the Determination of Metformin Hydrochloride, Saxagliptin Hydrochloride, and Dapagliflozin in Pharmaceuticals. CURR ANAL CHEM 2020. [DOI: 10.2174/1573407215666190131123029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background:
Type 2 diabetes mellitus is an expanding health problem. Binary antidiabetic
combinations of Metformin Hydrochloride (MET) with either Saxagliptin Hydrochloride (SAX),
or Dapagliflozin (DAP) are widely used. Review of the literature revealed that no single HPTLC
method has been reported for the simultaneous determination of MET, SAX, and DAP allowing the
determination of binary mixtures of any two of the three cited drugs in their tablets using the same
experimental conditions, an important advantage for quality control. The advantages of HPTLC
method relies on the simultaneous analysis of a large number of samples in a shorter analysis time,
less solvent consumption, and less expenses, compared with HPLC.
Objective:
The objective of the proposed method is to develop and validate a single and simple
HPTLC densitometric method for the simultaneous determination of MET, SAX, and DAP.
Methods:
Separation was performed using aluminum HPTLC sheets coated with silica gel 60 F254
with a mobile phase consisting of a mixture of acetonitrile: 1% w/v ammonium acetate in methanol
(9: 1, v/v). Scanning was performed at 210 nm.
Results and Discussion:
Linearity of the method was assessed in the concentration range of 0.25-10
μg/band for SAX and DAP and 0.25-25 μg/band for MET. The method was fully validated as per the
ICH guidelines. The proposed method provided error and deviation values of less than 2% assessing
good accuracy and precision.
Conclusion:
The method was successfully applied to the analysis of pharmaceutical tablets of
MET/SAX, MET/DAP, and SAX/DAP with high specificity.
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Affiliation(s)
- Afnan E. Abdelrahman
- College of Pharmacy, Department of Pharmaceutical Chemistry, King Saud University, Riyadh 11495, Saudi Arabia
| | - Hadir M. Maher
- College of Pharmacy, Department of Pharmaceutical Chemistry, King Saud University, Riyadh 11495, Saudi Arabia
| | - Nourah Z. Alzoman
- College of Pharmacy, Department of Pharmaceutical Chemistry, King Saud University, Riyadh 11495, Saudi Arabia
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Ofori-Asenso R, Ilomaki J, Chin KL, Mazidi M, Zomer E, Bell JS, Magliano DJ, Liew D. Dynamics of switching, adherence, and persistence of dipeptidyl peptidase-4 inhibitors use: A nationwide cohort study. Diabetes Res Clin Pract 2019; 158:107909. [PMID: 31697992 DOI: 10.1016/j.diabres.2019.107909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 11/29/2022]
Abstract
AIMS To characterise the patterns of switching, adherence, and persistence among adults aged ≥18 years with diabetes prescribed dipeptidyl peptidase-4 inhibitors (DPP-4is) in Australia. METHODS The analysis included 15,915 adults newly prescribed DPP-4is (sitagliptin = 9576; vildagliptin = 1130; saxagliptin = 1126; linagliptin = 3560; and alogliptin = 523). Multivariable logistic regression model was used to compare the non-adherence (proportion of days covered [PDC] <0.80) rates whereas Cox proportional hazards regression models were used to compare switching and non-persistence (≥90-day gap) among different DPP4-is over 12-months. RESULTS Overall, 36.0% (5722/15,915) of DPP-4i users were non-adherent and 30.0% (4775/15,915) were non-persistent at 12-months. Compared to sitagliptin, vildagliptin, linagliptin, and alogliptin were not associated with higher non-adherence and non-persistence. However, saxagliptin was associated with a higher likelihood of being non-adherent (odds ratio 1.41, 95% confidence interval [CI] 1.23-1.60) or non-persistent (hazard ratio 1.27, 95% CI 1.15-1.42) compared to sitagliptin. Just 3.2% of people switched between different DPP-4is. Compared to sitagliptin, people initiated on vildagliptin, saxagliptin, alogliptin, and linagliptin were more likely to switch. CONCLUSIONS We found no significant differences in the adherence and persistence rates between alogliptin, vildagliptin or linagliptin and sitagliptin. However, saxagliptin was associated with higher non-adherence and non-persistence compared to sitagliptin. Switching was lowest amongst users of sitagliptin.
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Affiliation(s)
- Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Jenni Ilomaki
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
| | - K L Chin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne Medical School, The University of University, Melbourne, Victoria, Australia.
| | - Mohsen Mazidi
- Twin Research and Genetic Epidemiology, Kings College London, London, United Kingdom.
| | - Ella Zomer
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - J S Bell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
| | | | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Kim HJ, Kim YS, Lee CB, Choi MG, Chang HJ, Kim SK, Yu JM, Kim TH, Lee JH, Ahn KJ, Kim K, Lee KW. Efficacy and Safety of Switching to Teneligliptin in Patients with Type 2 Diabetes Inadequately Controlled with Dipeptidyl Peptidase-4 Inhibitors: A 12-Week Interim Report. Diabetes Ther 2019; 10:1271-1282. [PMID: 31079357 PMCID: PMC6612358 DOI: 10.1007/s13300-019-0628-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Teneligliptin, an antidiabetic agent classified as a class III dipeptidyl peptidase-4 (DPP-4) inhibitor, has a unique structural feature that provides strong binding to DPP-4 enzymes. We investigated the efficacy and safety of switching patients with type 2 diabetes mellitus (T2DM) who had inadequate glycemic control on a stable dose of other DPP-4 inhibitors to teneligliptin. METHODS Patients with T2DM whose glycosylated hemoglobin (HbA1c) levels were ≥ 7% despite taking DPP-4 inhibitors other than teneligliptin, with or without other hypoglycemic agents, for at least 3 months were enrolled. The DPP-4 inhibitors taken before participating in the study were switched to 20 mg qd teneligliptin, and this was to be maintained for 52 weeks. The primary end point was the change in HbA1c levels after 12 weeks. Metabolic parameters including fasting plasma glucose (FPG) and blood lipids were assessed also. To assess safety, adverse and hypoglycemic events were monitored. The data from baseline to week 12 were used for analysis in this interim report. RESULTS The mean change in HbA1c levels from baseline to week 12 was - 0.44%. At week 12, the percentage of patients achieving HbA1c < 7.0% was 31.6% and that of achieving HbA1c < 6.5% was 11.4%, respectively. In 41.2% of patients, the HbA1c levels decreased by at least 0.5% at 12 weeks. The mean change in FPG levels from baseline to week 12 was - 11.5 mg/dl. No severe hypoglycemia was reported. CONCLUSION After switching to teneligliptin, HbA1c levels decreased significantly in patients with T2DM inadequately controlled with other DPP-4 inhibitors. TRIAL REGISTRATION ClinicalTrials.gov, NCT03793023. FUNDING Handok Inc.
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Affiliation(s)
- Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Young Sik Kim
- Department of Family Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Beom Lee
- Department of Internal Medicne, Hanyang University College of Medicine, Guri, Korea
| | - Moon-Gi Choi
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hyuk-Jae Chang
- Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Kyoung Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Myung Yu
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Tae Ho Kim
- Department of Internal Medicine, Seoul Medical center, Seoul, Korea
| | - Ji Hyun Lee
- Department of Internal Medicine, Catholic University of Daegu, Korea, Daegu, Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea
| | | | - Kwan Woo Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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Kalra S, Bajaj S, Unnikrishnan AG, Baruah MP, Sahay R, Hardik V, Kumar A. Therapeutic Experience of Saxagliptin as First Add-on after Metformin in Indian Type 2 Diabetes Patients: A Non-interventional, Prospective, Observational Study (ONTARGET-INDIA). Indian J Endocrinol Metab 2019; 23:312-317. [PMID: 31641633 PMCID: PMC6683677 DOI: 10.4103/ijem.ijem_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Dipeptidyl peptidase 4 (DPP4) inhibitors are widely used in type 2 diabetes mellitus (T2DM) patients but the data available in existing clinical trial programmes on DPP4 inhibitors include limited number of patients from India. Hence, this study attempted to understand usage, efficacy and safety of saxagliptin as first add-on after metformin in Indians with T2DM. METHODOLOGY It was a multicenter, prospective, non-interventional and observational study planned to enrol T2DM patients who were inadequately controlled with metformin alone and had been recently (i.e., within past 15 days) prescribed saxagliptin as an add-on to metformin. Type 1 diabetes mellitus, use of glucose lowering drugs apart from metformin or saxagliptin, pregnancy, lactation, and medical condition, which could interfere with safe completion of the study were excluded. RESULTS A total of 1109 participants (658 men and 451 women) with mean ± SD age of 51.17 ± 11.85 years were enrolled from 50 centres throughout India. Significant reduction was observed in mean ± SD change of HbA1c as - 0.86% ± 1.76 from baseline to after 3 months of therapy (P < 0.0001). The quality of life assessed by World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire was reported to be "good" or "neither good nor bad" by majority of the participants at baseline and after 3 months of treatment. A total of 15 adverse events (AEs) were reported in the study, however, no serious adverse event (SAE) occurred during the study. All AEs were of mild intensity and did not require any intervention. CONCLUSION Overall, saxagliptin in combination with metformin was generally well tolerated in Indian T2DM patients and new safety event identified is an increased risk of hospitalisation in heart failure patients. This study is also registered on Clinicaltrials.gov (NCT02588859).
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - A. G. Unnikrishnan
- Department of Clinical Diabetology and Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Center, Maya Ville, Barthakur Mill Road, Ulubari, Guwahati, Assam, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania General Hospital, Hyderabad, Telangana, India
| | - V. Hardik
- Department of Medical Affairs, AstraZeneca Pharma India Ltd, Bengaluru, Karnataka, India
| | - Amit Kumar
- Department of Medical Affairs, AstraZeneca Pharma India Ltd, Bengaluru, Karnataka, India
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Zhou XJ, Ding L, Liu JX, Su LQ, Dong JJ, Liao L. Efficacy and short-term side effects of sitagliptin, vildagliptin and saxagliptin in Chinese diabetes: a randomized clinical trial. Endocr Connect 2019; 8:318-325. [PMID: 30822272 PMCID: PMC6432871 DOI: 10.1530/ec-18-0523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/14/2022]
Abstract
AIMS To investigate the difference in the efficacy among dipeptidyl peptidase-4 (DPP-4) inhibitors in Chinese adults with newly diagnosed diabetes. MATERIALS AND METHODS In a multicenter, randomized study, we enrolled adults who were either treatment naive or off prior anti-hyperglycemic therapy for at least 3 months. Eligible patients had hemoglobin A1c (HbA1c) concentrations of 6.5-9.5%. Three hundred patients had been randomly allocated to sitagliptin 100 mg, once daily; vildagliptin 50 mg, twice daily and saxagliptin 5 mg, once daily for 12 weeks. Patients and investigators were masked to treatment assignment. The primary endpoint was change from baseline in HbA1c at week 12. This study was completed and registered with ClinicalTrials.gov, number NCT01703637. RESULTS Totally 277 patients were enrolled in the final analysis, and 93 patients received sitagliptin, 94 received vildagliptin and 90 received saxagliptin. Compared with baseline, adjusted mean differences in change from baseline HbA1c at week 12 were -0.50% (95% CI: -0.20 to -0.90), -0.65% (95% CI: -0.40 to -1.40), -0.70 (95% CI: -0.50 to -1.00) for sitagliptin, vildagliptin and saxagliptin group, respectively. The overall HbA1c-lowering effect was similar for all three selected DPP-4 inhibitors after adjustment for age and baseline HbA1c. Notably, in secondary outcome analysis, patients in vildagliptin group showed a significant decrease in total cholesterol levels, compared with participants in sitagliptin and saxagliptin groups. No significant between-group difference was shown in adverse events (AE). CONCLUSIONS The overall HbA1c-lowering effect and incidence of AE were similar for sitagliptin, vildagliptin and saxagliptin in Chinese adults with newly diagnosed diabetes.
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Affiliation(s)
- Xiao-jun Zhou
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Lin Ding
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Jia-xin Liu
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Le-qun Su
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Correspondence should be addressed to L Su or J Dong or L Liao: or or
| | - Jian-jun Dong
- Division of Endocrinology, Department of Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, Shandong, China
- Correspondence should be addressed to L Su or J Dong or L Liao: or or
| | - Lin Liao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Correspondence should be addressed to L Su or J Dong or L Liao: or or
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Men P, Li XT, Tang HL, Zhai SD. Efficacy and safety of saxagliptin in patients with type 2 diabetes: A systematic review and meta-analysis. PLoS One 2018; 13:e0197321. [PMID: 29787616 PMCID: PMC5963790 DOI: 10.1371/journal.pone.0197321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/29/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the comparative efficacy and safety of saxagliptin for type 2 diabetes (T2D). METHODS A systematic search of PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov and two Chinese databases for randomized controlled trials (RCTs) comparing saxagliptin with placebo or active comparators was performed up to July 2017. A complementary search was done to cover literature until March 2018. For continuous data, estimates were pooled using inverse variance methodology to calculate weighted mean differences (WMDs). Dichotomous data were presented as Mantel-Haenzel risk ratios (RRs). RESULTS Thirty-nine references of 30 RCTs involving 29,938 patients were analyzed. Compared with placebo, saxagliptin significantly reduced glycated hemoglobin (HbA1c, WMD -0.52%, 95% CI -0.60 to -0.44) and fasting plasma glucose (WMD -13.78 mg/dL, 95% CI -15.31 to -12.25), and increased the proportion of patients achieving HbA1c <7% (RR 1.64, 95% CI 1.53 to 1.75). When combined with submaximal-dose metformin, saxagliptin significantly increased the proportion of patients achieving HbA1c <7% compared with acarbose (RR 2.38, 95% CI 1.17 to 4.83) and uptitrated metformin (RR 1.30, 95% CI 1.04 to 1.63). Saxagliptin was similar to other DPP-4 inhibitors but inferior to liraglutide and dapagliflozin on glycemic control. Saxagliptin significantly decreased the incidences of overall adverse events compared with acarbose (RR 0.71, 95% CI 0.57 to 0.89) and liraglutide (RR 0.41, 95% CI 0.24 to 0.71) when added to metformin. Weight gain and hypoglycemia with saxagliptin was slightly but significantly higher than placebo and lower than sulfonylureas. Saxagliptin did not increase the risk of arthralgia, heart failure, pancreatitis and other adverse events. CONCLUSIONS Generally, saxagliptin has similar efficacy compared with most oral antidiabetic drugs and may be more effective than acarbose, while having a better safety profile than both acarbose and sulfonylureas.
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Affiliation(s)
- Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Xiao-tong Li
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Hui-lin Tang
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Suo-di Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
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11
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Wang LG, Wang H, Liu Q, Hua WC, Li CM. A network meta-analysis for efficacy and safety of seven regimens in the treatment of type II diabetes. Biomed Pharmacother 2017; 92:707-719. [PMID: 28586742 DOI: 10.1016/j.biopha.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 01/25/2023] Open
Abstract
The efficacy and safety of seven regimens based on metformin (placebo plus metformin, dapagliflozin plus metformin, vildagliptin plus metformin, saxagliptin plus metformin, empagliflozin plus metformin, exenatide plus metformin and sitagliptin plus metformin) on type 2 diabetes (T2D) were compared based on network meta-analysis. PubMed, Embase and Cochrane Library were applied in the computer-based retrieval process. Randomized controlled trials (RCTs) which were related with the above seven regimens based on metformin in the treatment of T2D were included in this study. Network meta-analysis merged the direct and indirect comparison evidence for the estimation of the weighted mean difference (WMD), odd ratios (ORs) and surface under the cumulative sequencing ranking curve (SUCRA) values. Eight eligible RCTs were applied in this network meta-analysis. The results demonstrated that: in terms of efficacy, the glycated hemoglobin (HbA1c) levels of T2D patients receiving vildagliptin plus metformin were relatively lower when compared with placebo plus metformin (WMD=-1.95, 95%CI=-3.70--0.23); in comparison with exenatide plus metformin, the triglyceride level in T2D patients taking vildagliptin plus metformin remained relatively lower (WMD=-1.36, 95%CI=-2.64--0.01). In terms of safety, the rate of adverse events in patients with T2D who received empagliflozin plus metformin was relatively lower when compared with saxagliptin plus metformin (OR=0.37, 95%CI=0.14-0.98). Furthermore, the SUCRA value of vildagliptin plus metformin was comparatively higher in efficacy, and that the SUCRA value of saxagliptin plus metformin was relatively lower in safety. The efficacy of vildagliptin plus metformin in patients with T2D is relatively better, while the safety of saxagliptin plus metformin in patients with T2D is relatively poorer.
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Affiliation(s)
- Li-Guo Wang
- Department of Pharmacy, Linyi People's Hospital, Linyi, 276003, PR China
| | - Hui Wang
- Department of Pharmacy, Linyi Chest Hospital, Linyi, 276003, PR China
| | - Qin Liu
- Department of Pharmacy, Chinese Medicine Hospital in Linyi City, Linyi, 276003, PR China
| | - Wei-Chang Hua
- Department of Pharmacy, The People's Hospital of Pingyi County, Linyi, 273300, PR China
| | - Chang-Ming Li
- Department of Pharmacy, Linyi People's Hospital, Linyi, 276003, PR China.
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Verma S, Goldenberg RM, Bhatt DL, Farkouh ME, Quan A, Teoh H, Connelly KA, Leiter LA, Friedrich JO. Dipeptidyl peptidase-4 inhibitors and the risk of heart failure: a systematic review and meta-analysis. CMAJ Open 2017; 5:E152-E177. [PMID: 28459046 PMCID: PMC5403656 DOI: 10.9778/cmajo.20160058] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Given recent discrepant results from randomized controlled trials (RCTs), we examined the totality of RCT evidence assessing the association between dipeptidyl peptidase-4 (DPP-4) inhibitors and heart failure. METHODS MEDLINE, Embase and ClinicalTrials.gov were searched without language restrictions to August 2016 for RCTs comparing DPP-4 inhibitors to placebo or no therapy for a period of 24 weeks or more. We included all heart failure outcomes when listed either as a serious adverse event or adverse event. Pooled analyses used random-effects. RESULTS We identified 100 RCTs (n = 79 867) - 3 large cardiovascular-safety RCTs (SAVOR-TIMI 53[saxagliptin]/n = 16 492, EXAMINE[alogliptin]/n = 5380, and TECOS[sitagliptin]/n = 14 735), and 97 smaller RCTs with a primary outcome that was usually change in glycated hemoglobin. Virtually all RCTs were high-quality, multicentre, placebo-controlled trials. A total of 96% (1192/1244) of heart failure events were prespecified, blindly adjudicated and required hospital admission. Pooled results suggested a 13% increase in heart failure (relative risk [RR] 1.13, 95% confidence interval [CI] 1.01-1.26, I2 = 0%; 32 RCTs, n = 54 640, 1244 events). When including only the 3 large RCTs, the increase was similar, but not significant (RR 1.14, 95% CI 0.97-1.32; 3 RCTs, n = 36 543, 1169 adjudicated events; number needed to harm 246) owing to heterogeneity (I2 = 42%), which lead to wider CIs, because SAVOR-TIMI 53 showed increased heart failure (RR 1.26, 95% CI 1.06-1.49) and TECOS showed no effect (RR 1.00, 95% CI 0.83-1.19). INTERPRETATION Despite pooled data from 79 867 patients, whether DPP-4 inhibitors increase heart failure overall or exhibit within-class differences remains unresolved. Our results highlight the importance of ongoing trials that are comparing DPP-4 inhibitors to placebo, although no large cardiovascular-safety RCTs are comparing different DPP-4 inhibitors to each other; consequently, these will address the overall but not class-difference question.
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Affiliation(s)
- Subodh Verma
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Ronald M Goldenberg
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Deepak L Bhatt
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Michael E Farkouh
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Adrian Quan
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Hwee Teoh
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Kim A Connelly
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Lawrence A Leiter
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
| | - Jan O Friedrich
- Divisions of Cardiac Surgery (Verma, Quan, Teoh), Endocrinology and Metabolism (Teoh, Leiter) and Cardiology (Connelly), and Departments of Surgery (Verma), Medicine (Connelly, Leiter, Friedrich) and Critical Care (Friedrich), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Departments of Surgery (Verma), Medicine (Farkouh, Connelly, Leiter, Friedrich), Nutritional Sciences (Leiter) and Interdepartmental Division of Critical Care (Friedrich), University of Toronto, Toronto, Ont.; LMC Diabetes & Endocrinology (Goldenberg), Thornhill, Ont.; Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School (Bhatt), Boston, Mass.; Peter Munk Cardiac Centre (Farkouh), University Health Network, Toronto, Ont
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Yu H, Woo VC. Emerging use of combination therapies for the management of type 2 diabetes - focus on saxagliptin and dapagliflozin. Diabetes Metab Syndr Obes 2017; 10:317-332. [PMID: 28769579 PMCID: PMC5533573 DOI: 10.2147/dmso.s117982] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIMS The aim of this article is to review the safety and efficacy data of dapagliflozin, saxagliptin, and their combination in the management of patients with type 2 diabetes. Evidence for the use of the single-tablet combination formulation is also presented. METHODS A nonsystematic literature review was performed using the Ovid, PubMed, and Google Scholar databases. RESULTS The addition of dapagliflozin/saxagliptin to metformin can lower mean hemoglobin A1c by as much as 1.47% and lead to weight loss of 0.5-2.0 kg. The risk of genital infections with combination therapy is lower than observed with dapagliflozin alone, suggestive of a protective effect. Adverse event risk at 52-week follow-up was not increased beyond that seen with either monotherapy. CONCLUSION Dapagliflozin/saxagliptin combination is generally well tolerated and is an effective tool in helping patients with diabetes improve glycemic control.
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Affiliation(s)
- Huan Yu
- Department of Medicine, Division of Endocrinology and Metabolism, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
- Correspondence: Huan Yu, Department of Medicine, Section of Endocrinology and Metabolism, Health Sciences Centre, University of Manitoba, 838-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4, Tel +1 204 957 3218, Fax +1 204 943 3516, Email
| | - Vincent C Woo
- Department of Medicine, Division of Endocrinology and Metabolism, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
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Cai X, Gao X, Yang W, Chen Y, Zhou L, Zhang S, Han X, Ji L. DPP-4 Inhibitor Treatment in Chinese Type 2 Diabetes Patients: A Meta-Analysis. Diabetes Technol Ther 2016; 18:784-793. [PMID: 27918671 DOI: 10.1089/dia.2016.0302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this meta-analysis was to assess the comprehensive clinical efficacy of dipeptidyl peptidase-IV (DPP-4) inhibitors in Chinese type 2 diabetes patients and to evaluate whether there is a different response to treatment with different kinds of DPP-4 inhibitors in those patients. METHODS Databases were systematically searched, and qualifying clinical studies of Chinese type 2 diabetes patients were included. RESULTS A total of 30 studies were included. Treatment with saxagliptin resulted in a significantly greater change from baseline in HbA1c levels (weighted mean difference [WMD], -1.28%; 95% CI, -1.37% to -1.19%); treatment with sitagliptin led to a significantly greater change from baseline (WMD, -1.17%; 95% CI, -1.46% to -0.89%); treatment with vildagliptin was associated with a significantly greater change in HbA1c levels (WMD, -0.77%; 95% CI, -0.88% to -0.65%); treatment with linagliptin led to a significantly greater change (WMD, -0.84%; 95% CI, -0.92% to -0.75%); and treatment with alogliptin also led to a significantly greater change (WMD, -0.91%; 95% CI, -1.48% to -0.33%). In terms of body weight, treatment with saxagliptin was associated with no significant decreases in Chinese type 2 diabetes mellitus (T2DM) patients (WMD, -0.17 kg, 95% CI, -4.26 to 3.92 kg). Treatment with sitagliptin and linagliptin was also associated with no significant changes in body weight (WMD, 0.16 and 0.11 kg, respectively, P > 0.05). CONCLUSIONS In Chinese type 2 diabetes patients, the efficacy of glucose control in all five kinds of DPP-4 inhibitor treatments was well confirmed, and no significant change in body weight was found.
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Affiliation(s)
- Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Xueying Gao
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Yifei Chen
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Lingli Zhou
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Simin Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital , Beijing, China
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Liu H, Hu Y, Li FF, Liu BL, Su XF, Ma JH. Blood Glucagon Levels Predict the Hemoglobin A1c Response to Saxagliptin in Patients with Type 2 Diabetes Inadequately Controlled with Metformin. Diabetes Ther 2016; 7:743-753. [PMID: 27734321 PMCID: PMC5118238 DOI: 10.1007/s13300-016-0200-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used as second-option medications when metformin fails. Variance of the glycated hemoglobin (HbA1c) response to DPP-4 inhibitions in patients with type 2 diabetes mellitus (T2DM) has been observed, but the characteristics which predict the response to DPP-4 inhibitor therapy are unclear. The aim of this study was to investigate the characteristics of α- and β-cell functions which might predict the efficacy of saxagliptin and facilitate personalization of treatment. METHODS We studied 60 patients with T2DM who had inadequate glycemic control [HbA1c7.0-13.0% (53-119 mmol/mol)) with metformin alone. The patients were treated with saxagliptin (5 mg, daily) and metformin (1000-2000 mg as former) for 12 weeks. Oral glucose tolerance tests were carried out at baseline and endpoint to evaluate α- and β-cell functions, and blood C-peptide, insulin, glucagon levels were tested. Blood glucose, HbA1c and weight were also observed. RESULTS Significant reduction of weight, HbA1c and glucagon was observed after 12-week treatment, while C-peptide, insulin and homeostasis model assessment-β increased (P < 0.05). Linear regression and receiver operating characteristic analysis showed that baseline HbA1c and 30 min-glucagon were correlated with the HbA1c response to saxagliptin, while the weight loss was correlated with gender, age and fasting-insulin level. Further analysis showed the 30 min-glucagon of 49.1 pmol/L was the optimal cutoff value to predict the efficacy of saxagliptin. CONCLUSIONS Saxagliptin added to metformin significantly improved glycemic control and α- and β-cell function. Blood glucagon level was a good predicting factor for the HbA1c response to saxagliptin, and it will help appropriate patient selection. TRIAL REGISTRATION Chinese Clinical Trial Register identifier, ChiCTR-PPR-15007045.
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Affiliation(s)
- Hao Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng-Fei Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Bing-Li Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Fei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jian-Hua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Gu S, Zeng Y, Yu D, Hu X, Dong H. Cost-Effectiveness of Saxagliptin versus Acarbose as Second-Line Therapy in Type 2 Diabetes in China. PLoS One 2016; 11:e0167190. [PMID: 27875596 PMCID: PMC5119856 DOI: 10.1371/journal.pone.0167190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/09/2016] [Indexed: 12/16/2022] Open
Abstract
Objective This study assessed the long-term cost-effectiveness of saxagliptin+metformin (SAXA+MET) versus acarbose+metformin (ACAR+MET) in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on MET alone. Methods Systematic literature reviews were performed to identify studies directly comparing SAXA+MET versus ACAR+MET, and to obtain diabetes-related events costs which were modified by hospital surveys. A Cardiff Diabetes Model was used to estimate the long-term economic and health treatment consequences in patients with T2DM. Costs (2014 Chinese yuan) were calculated from the payer’s perspective and estimated over a patient’s lifetime. Results SAXA+MET predicted lower incidences of most cardiovascular events, hypoglycemia events and fatal events, and decreased total costs compared with ACAR+MET. For an individual patient, the quality-adjusted life-years (QALYs) gained with SAXA+MET was 0.48 more than ACAR+MET at a cost saving of ¥18,736, which resulted in a cost saving of ¥38,640 per QALY gained for SAXA+MET versus ACAR+MET. Results were robust across various univariate and probabilistic sensitivity analyses. Conclusion SAXA+MET is a cost-effective treatment alternative compared with ACAR+MET for patients with T2DM in China, with a little QALYs gain and lower costs. SAXA is an effective, well-tolerated drug with a low incidence of adverse events and ease of administration; it is anticipated to be an effective second-line therapy for T2DM treatment.
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Affiliation(s)
- Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yuhang Zeng
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Demin Yu
- Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xiaoqian Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
- * E-mail:
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17
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Mosenzon O, Pollack R, Raz I. Treatment of Type 2 Diabetes: From "Guidelines" to "Position Statements" and Back: Recommendations of the Israel National Diabetes Council. Diabetes Care 2016; 39 Suppl 2:S146-53. [PMID: 27440827 DOI: 10.2337/dcs15-3003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the increased prevalence of type 2 diabetes worldwide, most patients are treated by their primary health care team (PHCT). PHCTs need guidance in choosing the best treatment regimen for patients, since the number of glucose-lowering agents (GLAs) is rapidly increasing, as is the amount of clinical data regarding these drugs. The American Diabetes Association/European Association for the Study of Diabetes Position Statement emphasizes the importance of personalized treatment and lists drug efficacy, risk of hypoglycemia, effect on weight, side effects, and cost as important parameters to consider when choosing GLAs. The suggested Israeli guidelines refocus earlier international recommendations from 2012 and 2015, based on emerging data from cardiovascular outcome trials as well as what we believe are important issues for patient care (i.e., durability, hypoglycemia risk, and weight gain).
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Affiliation(s)
- Ofri Mosenzon
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Rena Pollack
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Itamar Raz
- Diabetes Unit, Division of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
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Ji LN, Pan CY, Lu JM, Li H, Zhu DL, Li Q, Li QF, Peng YD, Tian HM, Yao C, Zhao ZG, Wang L, Wang BH. Efficacy and safety of combination therapy with vildagliptin and metformin versus metformin uptitration in Chinese patients with type 2 diabetes inadequately controlled with metformin monotherapy: a randomized, open-label, prospective study (VISION). Diabetes Obes Metab 2016; 18:775-82. [PMID: 27406394 DOI: 10.1111/dom.12667] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 02/05/2023]
Abstract
AIMS To compare the efficacy and safety of combination of vildagliptin and metformin therapy with metformin uptitration in Chinese patients with type 2 diabetes (T2DM) inadequately controlled with low-dose metformin. METHODS In this 24-week prospective, randomized, multicentre, open-label study, patients with T2DM inadequately controlled with metformin ≤1000 mg daily were divided 1 : 1 : 1 : 1 into four prespecified subgroups based on age and body mass index (BMI). Patients in each subgroup were randomized 5 : 1 to receive either vildagliptin (50 mg twice daily) plus metformin [500 mg twice daily; vildagliptin and low-dose metformin (VLDM) group] or metformin uptitration [1000 mg twice daily; high-dose metformin (HDM) group]. The primary endpoint was change in glycated haemoglobin (HbA1c) from baseline at week 24. The key secondary endpoints included percentage of patients achieving target HbA1c without adverse gastrointestinal (GI) events and mean change in fasting plasma glucose (FPG) from baseline to week 24. RESULTS A total of 3084 patients were randomized. HbA1c reduction of 0.54% at week 24 in the VLDM group was non-inferior and statistically superior compared with 0.40% in the HDM group (P < 0.0001). VLDM's non-inferiority to HDM was confirmed in the four subgroups and its superiority was shown for all subgroups (p < 0.05) except for the subgroup of patients aged <60 years with a BMI of ≥24 kg/m(2) . Compared with HDM, VLDM significantly increased the percentage of patients achieving HbA1c ≤6.5% and HbA1c ≤6.5% without GI events. FPG levels in the VLDM group were lower at week 24 numerically than in the HDM group. The two treatment arms had similar safety profiles. CONCLUSIONS VLDM was non-inferior and statistically superior to HDM in glycaemic control in Chinese patients with T2DM inadequately controlled with low-dose metformin.
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Affiliation(s)
- L-N Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, China
| | - C-Y Pan
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - J-M Lu
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China
| | - H Li
- Department of Endocrinology, Sir Run Run Shaw Hospital, Zhejiang University Medical College, Hangzhou, China
| | - D-L Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Q Li
- Department of Endocrinology and Metabolism, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Q-F Li
- Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Y-D Peng
- Department of Endocrinology, Shanghai First People's Hospital, Shanghai, China
| | - H-M Tian
- Department of Endocrinology, West China Hospital, Sichuan University, Chengdu, China
| | - C Yao
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Z-G Zhao
- Department of Endocrinology, Zhengzhou Yihe Hospital, Zhengzhou, China
| | - L Wang
- Novartis Pharmaceuticals (China), Shanghai, China
| | - B-H Wang
- Novartis Pharmaceuticals (China), Shanghai, China
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Xiaoyan C, Jing W, Xiaochun H, Yuyu T, Shunyou D, Yingyu F. Effects of vildagliptin versus saxagliptin on daily acute glucose fluctuations in Chinese patients with T2DM inadequately controlled with a combination of metformin and sulfonylurea. Curr Med Res Opin 2016; 32:1131-6. [PMID: 26950829 DOI: 10.1185/03007995.2016.1162773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The present study aimed to compare the effects of the dipeptidyl peptidase-4 (DPP-4) inhibitors vildagliptin and saxagliptin on 24 hour acute glucose fluctuations in Chinese patients with type 2 diabetes mellitus (T2DM) inadequately controlled with a combination of metformin and sulfonylurea. Research design and methods This was a 24 week, prospective, randomized, open-label, active-controlled study. Patients (N = 73) with T2DM who had inadequate glycemic control (HbA1c 7.0%-10.0%) with a stable dosage of metformin plus gliclazide for more than 3 months were randomized to receive either vildagliptin 50 mg twice daily (BID, n = 37) or saxagliptin 5 mg once daily (QD, n = 36). Change in mean amplitude of glycemic excursions (MAGE) was assessed at the end of 24 weeks. Results At baseline, the mean (±SD) age was 62.9 ± 6.55 years, disease duration was 7.0 ± 2.33 years, and HbA1c was 8.4 ± 0.68%. After 24 weeks of treatment, the MAGE decreased from 5.81 ± 1.16 mmol/L to 4.06 ± 0.86 mmol/L (p<0.001) in the vildagliptin group and from 5.66 ± 1.14 mmol/L to 4.79 ± 1.25 mmol/L (p = 0.003) in the saxagliptin group. The mean change in MAGE in the vildagliptin group was significantly greater than that in the saxagliptin group (1.74 ± 0.48 mmol/L vs. 0.87 ± 0.40 mmol/L, p<0.001). The mean change in HbA1c, from baseline to the study endpoint, in the vildagliptin and saxagliptin groups, was 1.22 ± 0.40% and 1.07 ± 0.36%, respectively, with no significant difference between the groups (p = 0.091). The overall safety and tolerability of vildagliptin and saxagliptin were similar. The limitations of the study were a small number of patients and open-label administration of the study drug. Conclusion Vildagliptin produced a significantly greater reduction in acute glucose fluctuations compared with saxagliptin when added to a dual combination of metformin and sulfonylurea in Chinese patients with T2DM. Chinese clinical trial registration number ChiCTR-TRC-13003858.
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Affiliation(s)
- Chen Xiaoyan
- a The First Affiliated Hospital of Guangzhou Medical University , Endocrinology Department , Guangzhou , China
| | - Wang Jing
- a The First Affiliated Hospital of Guangzhou Medical University , Endocrinology Department , Guangzhou , China
| | - Huang Xiaochun
- a The First Affiliated Hospital of Guangzhou Medical University , Endocrinology Department , Guangzhou , China
| | - Tan Yuyu
- a The First Affiliated Hospital of Guangzhou Medical University , Endocrinology Department , Guangzhou , China
| | - Deng Shunyou
- a The First Affiliated Hospital of Guangzhou Medical University , Endocrinology Department , Guangzhou , China
| | - Fu Yingyu
- a The First Affiliated Hospital of Guangzhou Medical University , Endocrinology Department , Guangzhou , China
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Bekiari E, Rizava C, Athanasiadou E, Papatheodorou K, Liakos A, Karagiannis T, Mainou M, Rika M, Boura P, Tsapas A. Systematic review and meta-analysis of vildagliptin for treatment of type 2 diabetes. Endocrine 2016; 52:458-80. [PMID: 26714458 DOI: 10.1007/s12020-015-0841-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/19/2015] [Indexed: 02/08/2023]
Abstract
This systematic review and meta-analysis provides an update on the efficacy and safety of vildagliptin for treatment of type 2 diabetes mellitus (T2DM). We searched MEDLINE, COCHRANE, EMBASE and the drug manufacturer's website for randomised controlled trials of vildagliptin in patients with T2DM. Sixty-nine studies (28,006 patients) were included in the meta-analysis. Compared with placebo vildagliptin reduced HbA1c (weighted mean difference WMD -0.69 %; 95 % CI -0.83 to -0.56 %; I (2) = 82 %), and it was as effective as other antidiabetic agents (WMD -0.01 %; 95 % CI -0.16 to 0.14 %; I (2) = 93 %), without increasing the risk for hypoglycemia (OR 0.83; 95 % CI 0.59 to 1.16; I (2) = 0 % vs. placebo, and OR 0.19; 95 % CI 0.15 to 0.24; I (2) = 78 % versus active comparators). However, it was associated with an increase in the incidence of arthralgia compared with other comparators (OR 1.23; 95 % CI 1.02 to 1.48; I (2) = 0 %). On the contrary, vildagliptin did not increase the incidence of pancreatitis (OR 0.97; 95 % CI 0.37 to 2.53; I (2) = 0 %), serious adverse events (OR 0.98; 95 % CI 0.88 to 1.09; I (2) = 0 %) or death (OR 1.10, 95 % CI 0.75 to 1.61; I (2) = 0 %). Finally, odds ratio (OR) for heart failure, and overall cardiovascular and cerebrovascular events was 0.77 (95 % CI 0.46 to 1.30; I (2) = 0 %) and 0.91 (95 % CI 0.73 to 1.14; I (2) = 0 %), respectively. Vildagliptin is an effective and safe therapeutic option for patients with T2DM, both as monotherapy and as add-on treatment.
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Affiliation(s)
- Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece
- Diabetes Centre, Second Medical Department, Aristotle University Thessaloniki, Thessaloníki, Greece
| | - Chrysoula Rizava
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece
| | - Eleni Athanasiadou
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece
| | - Konstantinos Papatheodorou
- Diabetes Centre, Second Medical Department, Aristotle University Thessaloniki, Thessaloníki, Greece
- Second Medical Department, Democritus University Thrace, Alexandroupoli, Greece
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece
| | - Maria Mainou
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece
| | - Maria Rika
- Diabetes Centre, Second Medical Department, Aristotle University Thessaloniki, Thessaloníki, Greece
| | - Panagiota Boura
- Second Medical Department, Aristotle University Thessaloniki, Thessaloníki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642, Thessaloníki, Greece.
- Diabetes Centre, Second Medical Department, Aristotle University Thessaloniki, Thessaloníki, Greece.
- Harris Manchester College, University of Oxford, Oxford, UK.
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Abstract
Sitagliptin, a dipeptidyl peptidase 4 inhibitor, was the first in its class to receive approval from the US FDA in 2006 for the treatment of Type 2 diabetes mellitus. It has been evaluated in numerous clinical trials and has several attractive features as an antidiabetic agent, including a low risk for hypoglycemia, a neutral effect on weight, and an ability to be used in chronic kidney disease and more. This article provides an up-to-date discussion of the pharmacokinetics/pharmacodynamics, clinical efficacy, safety and tolerability of sitagliptin.
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Affiliation(s)
- Maria Lee
- Emory University School of Medicine, Medicine/Endocrinology, 1303 Woodruff Memorial Research Building,101 Woodruff Circle, Suite 1303, Atlanta, GA 30322, USA
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Pharmacogenetics and individual responses to treatment of hyperglycemia in type 2 diabetes. Pharmacogenet Genomics 2015; 25:475-84. [DOI: 10.1097/fpc.0000000000000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Srividya S, Swetha E, Veeresham C. Development and Validation of a High Performance Thin Layer Chromatographic Method for Quantitative Analysis of Saxagliptin. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ajac.2015.610076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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