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Dipeptidyl peptidase-4 inhibitors and cardiovascular and renal disease in type 2 diabetes: What have we learned from the CARMELINA trial?
| Content Provider | SAGE Publishing |
|---|---|
| Author | Hanssen, Nordin Mj Jandeleit-Dahm, Karin Am |
| Copyright Year | 2019 |
| Abstract | Dipeptidyl peptidase-4 inhibitors are a relatively new class of oral anti-hyperglycaemic drugs to treat type 2 diabetes through prevention of degradation of incretins by the dipeptidyl peptidase-4 enzyme. The large trials evaluating the dipeptidyl peptidase-4 inhibitors sitagliptin, alogliptin and saxagliptin demonstrated safety for cardiovascular disease. Post hoc analyses on renal endpoints yielded similar findings. Linagliptin is the latest dipeptidyl peptidase-4 inhibitor evaluated in the CARMELINA trial. CARMELINA included individuals with type 2 diabetes and high cardiovascular and renal risk. Even in this setting, linagliptin displayed cardiovascular safety. CARMELINA also removed initial concerns for heart failure as a class-specific side-effect of dipeptidyl peptidase-4 inhibitors, as no signal for heart failure was found. Although numerically low, CARMELINA did confirm increased rates of pancreatitis in the linagliptin group, suggesting that pancreatitis is a class-specific side-effect of dipeptidyl peptidase-4 inhibitors. Linagliptin reduced progression of albuminuria, but had no effect on other hard renal endpoints. Overall, dipeptidyl peptidase-4 inhibitors are safe but do not confer significant reductions in complications observed for some of the other new glucose-lowering drugs. However, linagliptin is a safe alternative in renal impairment, without dose adjustment. Furthermore, dipeptidyl peptidase-4 inhibitors may hold value as alternatives to sulfonyl-urea derivatives or as an add-on therapy to delay insulin prescription given their favourable safety profile. |
| Related Links | https://journals.sagepub.com/doi/pdf/10.1177/1479164119842339?download=true |
| Starting Page | 303 |
| Ending Page | 309 |
| Page Count | 7 |
| ISSN | 14791641 |
| Issue Number | 4 |
| Volume Number | 16 |
| Journal | Diabetes and Vascular Disease Research (DVR) |
| e-ISSN | 17528984 |
| DOI | 10.1177/1479164119842339 |
| Language | English |
| Publisher | Sage Publications UK |
| Publisher Date | 2019-04-24 |
| Publisher Place | London |
| Access Restriction | Open |
| Rights Holder | © The Author(s) 2019 |
| Subject Keyword | Dipeptidyl peptidase-4 inhibitors chronic kidney disease clinical trials cardiovascular disease type 2 diabetes |
| Content Type | Text |
| Resource Type | Article |
| Subject | Endocrinology, Diabetes and Metabolism Internal Medicine Cardiology and Cardiovascular Medicine |
