SUMMARYWhat is known and Objective: Dipeptidyl peptidase-4 (DPP-4) inhibitors are a relatively new class of drugs for the management of type 2 diabetes (T2DM). Vildagliptin is an oral DPP-4 inhibitor approved in more than 70 countries. The purpose of this meta-analysis is to provide an update on the clinical efficacy and safety of vildagliptin in patients with T2DM. Methods: A literature search identified 30 randomized controlled trials comparing vildagliptin with comparators (placebo or other hypoglycaemic agents). Meta-analyses were conducted for HbA1c, weight, fasting plasma glucose (FPG), hypoglycaemia and other adverse events. The outcomes of HbA1c, weight and FPG were analysed as weighted mean differences (WMD), and the number of ADRs events as relative risks (RR). Results: Compared with placebo, vildagliptin lowered HbA1c {WMD, )0AE77% [95% confidence interval (CI), )0AE96% to )0AE58%] for 100 mg/day of vildagliptin and )0AE58% [95% CI, )0AE72% to )0AE44%] for 50 mg/day of vildagliptin}. The effect was non-inferior to thiazolidinediones, sulfonylureas and aglycosidase inhibitors, but inferior to metformin. Compared with placebo, treatment with 50 mg/day of vildagliptin caused neutral weight changes, while 100 mg/day of vildagliptin resulted in slight weight gain [0AE95 kg (95% CI, 0AE73-1AE17 kg)]. In addition, compared to comparators, vildagliptin was not associated with an increase in overall risk for any adverse events [RR, 0AE97 (95% CI, 0AE94-0AE99)]. The incidence of hypoglycaemia was low with vildagliptin, and the risk with vildagliptin was not significantly different from the comparators [0AE85 (95% CI, 0AE49-1AE47)]. The use of vildagliptin did not display any increased risks of infection [1AE03 (95% CI, 0AE94-1AE13) for nasopharyngitis and 1AE07 (95% CI, 0AE90-1AE27) for upper respiratory tract infection].What is new and Conclusion: Vildagliptin is effective in glycaemic control with a low risk of hypoglycaemia and other adverse reactions. This may have an important impact on patient adherence to this medication. WHAT IS KNOWN AND OBJECTIVEType 2 diabetes (T2DM) is a rapidly growing disease, presenting a major challenge to health care systems worldwide. It is estimated that approximately 6AE6% of the world's population had diabetes in 2010, and this figure is projected to increase to 7AE8% by 2030.1 There are a variety of antidiabetic agents available, including metformin, sulfonylureas, thiazolidinediones, a-glycosidase inhibitors, prandial glucose regulators and insulin in various forms. Multiple studies have shown that improving glycaemic control and lowering HbA1c in patients with T2DM can reduce the rate of long-term micro-vascular and neuropathic complications, as well as mortality.2-4 A metaanalysis of five randomized controlled trials (RCT) involving intensive blood glucose management has demonstrated that for every 0AE9% decrease in HbA1c value, there is a 17% reduction in non-fatal myocardial infarction and a 15% reduction in coronary artery disease events. 4 Consensus guidelines from...
Background Allergic rhinitis (AR) is a major public health problem and is increasing worldwide. AR affects children's learning efficiency, sleep quality, and other major aspects of life. Sublingual immunotherapy (SLIT) is effective and safe for children with seasonal AR, but for children with perennial allergic rhinitis (PAR) caused by house dust mites (HDM), its effectiveness and safety is less convincing. Methods Medical literature databases up to 2019 were searched for published and unpublished pieces of evidence. Studies were individually screened by 2 reviewers against the eligibility criteria. Primary outcomes were total nasal symptoms scores (TNSS) and total medication scores (TMS). The secondary outcomes were total ocular symptoms scores and adverse events (AEs). Random effect models and fixed‐effect models were used to calculate the standard mean difference (SMD) and risk ratio (RR), respectively. Results We identified 3772 abstracts, of which only 16 studies met our established criteria. SLIT significantly reduced TNSS (SMD –1.73; 95% CI, –2.62 to –0.84; p = 0.0001) and TMS (SMD –1.21; 95% CI, –1.75 to –0.67; p < 0.00001). Compared with children taking placebo, children taking SLIT were 1.08 (95% CI, 1 to 1.17; p = 0.05), 1.15 (95% CI, 0.87 to 1.51; p = 0.32), and 1.68 (95% CI, 0.68 to 4.11; p = 0.26) times more likely to develop mild, moderate, and severe AEs, respectively. Conclusion HDM SLIT can effectively alleviate TNSS and TMS in children with PAR, but care should be taken to avoid harm due to possible adverse drug reactions.
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