Dipeptidyl Peptidase-4 Inhibitors and Risk for Heart Failure

March 3, 2016

Dipeptidyl Peptidase-4 Inhibitors and Risk for Heart Failure

  1. Paul S. Mueller, MD, MPH, FACP

These drugs were associated with a small excess risk (of borderline significance) for HF-associated hospitalizations in patients at high baseline risk.

  1. Paul S. Mueller, MD, MPH, FACP

In a recent randomized trial, the dipeptidyl peptidase (DPP)-4 inhibitor saxagliptin (Onglyza), used for treating patients with type 2 diabetes, was associated with a small but statistically significant rise in hospital admissions for heart failure (NEJM JW Gen Med Oct 1 2013 and N Engl J Med 2013; 369:1317); however, other trials have not shown “gliptin” drugs to confer risk for heart failure (NEJM JW Gen Med Jul 15 2015 and N Engl J Med 2015; 373:232). In this meta-analysis, researchers determined whether use of DPP-4 inhibitors is associated with excess risk for heart failure (HF) or hospitalization for HF in patients with type 2 diabetes.

In 38 randomized trials (32,000 patients; mean age range, 50–73; follow-up duration, 12–206 weeks), no significant difference was noted in HF risk between DPP-4 inhibitor recipients and controls (who usually received placebo or sulfonylureas); the event rate was about 0.3% for each group. In five trials that involved 37,000 patients who were considered to be at high risk for HF at baseline (mean age range, 61–67; follow-up duration, 52–156 weeks), hospitalization for HF was more common in DPP-4 inhibitor patients than in controls (event rates, 3.4% for DPP-4 inhibitors and 3.0% for control therapies; borderline statistical significance). Low-quality evidence from 12 observational studies (1.8 million patients) yielded similar results.

Comment

Use of DPP-4 inhibitors generally was not associated with excess risk for HF events in patients with type 2 diabetes. However, use of DPP-4 inhibitors was associated with marginally higher risk for HF hospitalization in people with type 2 diabetes who were also at excess risk for HF, a finding that the authors recommend be considered when prescribing antidiabetic drugs for such patients.

Editor Disclosures at Time of Publication

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Editorial boards Medical Knowledge Self-Assessment Program (MKSAP 17 General Internal Medicine Committee); MKSAP 17 General Internal Medicine (author/contributor) Leadership positions in professional societies American Osler Society (Vice President)

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SALEH ALI Physician, Family Medicine/General Practice, Sudan

Not comment.

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