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Comparative cardiovascular risks of dipeptidyl peptidase 4 inhibitors with other second- and third-line antidiabetic drugs in patients with type 2 diabetes.
Br J Clin Pharmacol. 2017 07; 83(7):1556-1570.BJ

Abstract

AIMS

Dipeptidyl peptidase 4 inhibitors (DPP4is) are suggested as a second- and third-line antidiabetic treatment for type 2 diabetes. Previous studies assessed only the cardiovascular effects of DPP4is as a second-line treatment, included sulphonylurea as the only comparator, and yielded inconclusive results on the risk of heart failure. The present study therefore evaluated the comparative cardiovascular risks of DPP4is with other second- and third-line antidiabetic drugs.

METHODS

Based on a large nationwide diabetic cohort, 113 051 patients with type 2 diabetes newly on metformin-based dual or triple therapy were identified in 2009-2011 and followed until 2013, or death if this occurred sooner. Primary interest targeted hospitalizations for ischaemic stroke, myocardial infarction and heart failure. Secondary outcomes were hypoglycaemia and all-cause mortality. Cox proportional hazards models were performed to assess time-to-event hazard ratio between propensity score-matched antidiabetic treatment groups.

RESULTS

DPP4is as a second-line add-on to metformin had a significantly lower stroke risk [hazard ratio (HR) 0.817 (95% confidence interval 0.687, 0.971)] and all-cause mortality [HR 0.825 (0.687, 0.992)] than those for sulphonylurea. DPP4is as a third-line add-on to metformin and sulphonylurea combined dual therapy had a significantly lower risk for stroke [HR 0.826 (0.740, 0.923)] and all-cause mortality [HR 0.784 (0.701, 0.878)] than those for acarbose, and significantly lower risks for stroke [HR 0.653 (0.542, 0.786)], heart failure [HR 0.721 (0.568, 0.917)] and all-cause mortality [HR 0.689 (0.594, 0.703)] than those for meglitinide.

CONCLUSIONS

DPP4is as a second- or third-line add-on treatment provided cardiovascular benefits and posed no increased risks for heart failure, hypoglycaemia or death.

Authors+Show Affiliations

Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Pharmacy, Chang Gung Memorial Hospital-Linkou, Tao-Yuan, Taiwan.Taiwan Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Public Health, China Medical University, Taichung, Taiwan.Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28109184

Citation

Ou, Huang-Tz, et al. "Comparative Cardiovascular Risks of Dipeptidyl Peptidase 4 Inhibitors With Other Second- and Third-line Antidiabetic Drugs in Patients With Type 2 Diabetes." British Journal of Clinical Pharmacology, vol. 83, no. 7, 2017, pp. 1556-1570.
Ou HT, Chang KC, Li CY, et al. Comparative cardiovascular risks of dipeptidyl peptidase 4 inhibitors with other second- and third-line antidiabetic drugs in patients with type 2 diabetes. Br J Clin Pharmacol. 2017;83(7):1556-1570.
Ou, H. T., Chang, K. C., Li, C. Y., & Wu, J. S. (2017). Comparative cardiovascular risks of dipeptidyl peptidase 4 inhibitors with other second- and third-line antidiabetic drugs in patients with type 2 diabetes. British Journal of Clinical Pharmacology, 83(7), 1556-1570. https://doi.org/10.1111/bcp.13241
Ou HT, et al. Comparative Cardiovascular Risks of Dipeptidyl Peptidase 4 Inhibitors With Other Second- and Third-line Antidiabetic Drugs in Patients With Type 2 Diabetes. Br J Clin Pharmacol. 2017;83(7):1556-1570. PubMed PMID: 28109184.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative cardiovascular risks of dipeptidyl peptidase 4 inhibitors with other second- and third-line antidiabetic drugs in patients with type 2 diabetes. AU - Ou,Huang-Tz, AU - Chang,Kai-Cheng, AU - Li,Chung-Yi, AU - Wu,Jin-Shang, Y1 - 2017/02/27/ PY - 2016/08/27/received PY - 2017/01/10/revised PY - 2017/01/18/accepted PY - 2017/1/22/pubmed PY - 2018/4/4/medline PY - 2017/1/22/entrez KW - cardiovascular diseases KW - dipeptidyl peptidase 4 inhibitors KW - hypoglycaemia KW - type 2 diabetes SP - 1556 EP - 1570 JF - British journal of clinical pharmacology JO - Br J Clin Pharmacol VL - 83 IS - 7 N2 - AIMS: Dipeptidyl peptidase 4 inhibitors (DPP4is) are suggested as a second- and third-line antidiabetic treatment for type 2 diabetes. Previous studies assessed only the cardiovascular effects of DPP4is as a second-line treatment, included sulphonylurea as the only comparator, and yielded inconclusive results on the risk of heart failure. The present study therefore evaluated the comparative cardiovascular risks of DPP4is with other second- and third-line antidiabetic drugs. METHODS: Based on a large nationwide diabetic cohort, 113 051 patients with type 2 diabetes newly on metformin-based dual or triple therapy were identified in 2009-2011 and followed until 2013, or death if this occurred sooner. Primary interest targeted hospitalizations for ischaemic stroke, myocardial infarction and heart failure. Secondary outcomes were hypoglycaemia and all-cause mortality. Cox proportional hazards models were performed to assess time-to-event hazard ratio between propensity score-matched antidiabetic treatment groups. RESULTS: DPP4is as a second-line add-on to metformin had a significantly lower stroke risk [hazard ratio (HR) 0.817 (95% confidence interval 0.687, 0.971)] and all-cause mortality [HR 0.825 (0.687, 0.992)] than those for sulphonylurea. DPP4is as a third-line add-on to metformin and sulphonylurea combined dual therapy had a significantly lower risk for stroke [HR 0.826 (0.740, 0.923)] and all-cause mortality [HR 0.784 (0.701, 0.878)] than those for acarbose, and significantly lower risks for stroke [HR 0.653 (0.542, 0.786)], heart failure [HR 0.721 (0.568, 0.917)] and all-cause mortality [HR 0.689 (0.594, 0.703)] than those for meglitinide. CONCLUSIONS: DPP4is as a second- or third-line add-on treatment provided cardiovascular benefits and posed no increased risks for heart failure, hypoglycaemia or death. SN - 1365-2125 UR - https://www.unboundmedicine.com/medline/citation/28109184/Comparative_cardiovascular_risks_of_dipeptidyl_peptidase_4_inhibitors_with_other_second__and_third_line_antidiabetic_drugs_in_patients_with_type_2_diabetes_ L2 - https://doi.org/10.1111/bcp.13241 DB - PRIME DP - Unbound Medicine ER -