A comparison of efficacy and safety of vildagliptin and gliclazide in combination with metformin in patients with Type 2 diabetes inadequately controlled with metformin alone: a 52‐week, randomized study

Filozof, Claudia; Gautier, Jean‐François

doi:10.1111/j.1464-5491.2010.02938.x

Cited by 126 publications

(49 citation statements)

References 29 publications

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“…However, in the present review, only head-to-head trials vs active comparators are presented in brief. Gliptins have also been compared with SUs (glimepiride, glipizide, gliclazide) [27][28][29][30][31][32][33][34], TZDs (pioglitazone 30 mg, rosiglitazone 8 mg) [35][36][37][38][39] and GLP-1 receptor agonists (exenatide, liraglutide) [36,40,41]. However, only one head-to-head study compared two different DPP-4 inhibitors in the same trial: saxagliptin 5 mg with sitaglitptin 100 mg as add-ons to basal metformin therapy [42].…”

Section: Gliptins Combined With Metforminmentioning

confidence: 99%

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

Scheen¹

2012

Diabetes & Metabolism

174

124

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Dipeptidyl peptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes. Direct comparisons with active glucose-lowering comparators in drug-naive patients have demonstrated that DPP-4 inhibitors exert slightly less pronounced HbA 1c reduction than metformin (with the advantage of better gastrointestinal tolerability) and similar glucose-lowering effects as with a thiazolidinedione (TZD; with the advantage of no weight gain). In metformin-treated patients, gliptins were associated with similar HbA 1c reductions compared with a sulphonylurea (SU; with the advantage of no weight gain, considerably fewer hypoglycaemic episodes and no need for titration) and a TZD (with the advantage of no weight gain and better overall tolerability). DPP-4 inhibitors also exert clinically relevant glucose-lowering effects compared with a placebo in patients treated with SU or TZD (of potential interest when metformin is either not tolerated or contraindicated), and as oral triple therapy with a good tolerability profile when added to a metformin-SU or pioglitazone-SU combination. Several clinical trials also showed a consistent reduction in HbA 1c when DPP-4 inhibitors were added to basal insulin therapy, with no increased risk of hypoglycaemia. Because of the complex pathophysiology of type 2 diabetes and the complementary actions of glucose-lowering agents, initial combination of a DPP-4 inhibitor with either metformin or a glitazone may be applied in drug-naive patients, resulting in greater efficacy and similar safety compared with either drug as monotherapy. However, DPP-4 inhibitors were less effective than GLP-1 receptor agonists for reducing HbA 1c and body weight, but offer the advantage of being easier to use (oral instead of injected administration) and lower in cost. Only one head-tohead trial demonstrated the non-inferiority of saxagliptin vs sitagliptin. Clearly, more trials of direct comparisons between different incretin-based therapies are needed. Because of their pharmacokinetic characteristics, pharmacodynamic properties (glucose-dependent glucose-lowering effect) and good overall tolerability profile, DPP-4 inhibitors may have a key role to play in patients with renal impairment and in the elderly. The role of DPP-4 inhibitors in the therapeutic armamentarium of type 2 diabetes is rapidly evolving as their potential strengths and weaknesses become better defined mainly through controlled clinical trials. Keywords:Clinical trial-DPP-4 inhibitor; Alogliptin; Linagliptin; Saxagliptin; Sitagliptin; Vildagliptin; Type 2 diabetes mellitus; Review Résumé Les inhibiteurs de la DPP-4 dans le traitement du diabète de type 2 : revue critique des essais cliniques contrôlés.Les inhibiteurs de la dipeptidylpeptidase-4 (DPP-4) offrent de nouvelles options pour le traitement du diabète de type 2. Des comparaisons directes avec d'autres médicaments antidiabétiques chez des patients naïfs de tout traitement ont démontré que les inhibiteurs de la DPP-4 étaient un peu moins puissants pour diminuer ...

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Section: Gliptins Combined With Metforminmentioning

confidence: 99%

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

Scheen¹

2012

Diabetes & Metabolism

174

124

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“…In total,19 studies were included in the base case analysis at 24-weeks ± 6 weeks [7,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] (Table S2) and a further 4 were eligible for the sensitivity analysis due to timeframe (± 8 weeks) and quality issues (Table S4). Of the 15 studies reporting data at the 52-week time point, 8 were included in the base case analysis [8,[42][43][44][45][46][47][48] (Table S3) with the remaining 7 assessed in the sensitivity analysis for the same reasons (timeframe and quality issues) (Table S4). Two included studies presented outcomes at both 24-and 52-weeks [23,24] and one study reported data from two citations [23,57].…”

Section: Systematic Review Search Resultsmentioning

confidence: 99%

Systematic Review and Network Meta-analysis to Compare Dapagliflozin with other Diabetes Medications in Combination with Metformin for Adults with Type 2 Diabetes

Barnett

Me²,

Fenici³

et al. 2014

Intern Med

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Objective: A network meta-analysis (NMA) update was undertaken to evaluate the sodium glucose cotransporter-2 (SGLT-2) inhibitor, dapagliflozin, versus other antidiabetes medications as add-on to metformin. This update allowed inclusion of a new drug class (glucagon-like peptide-1 [GLP-1] analogues), a new time point (24-weeks) and covariate analysis. Methods:The systematic review identified randomised controlled trials involving patients with type-2 diabetes mellitus (T2DM) inadequately controlled on metformin. Comparators included dipeptidyl peptidase-4 inhibitors (DPP-4i), thiazolidinediones (TZDs), GLP-1s, sulfonylureas (SUs) and dapagliflozin. Bayesian NMA was conducted at 24-and 52-weeks for mean change in HbA1c, systolic blood pressure (SBP), weight, and proportion of patients experiencing hypoglycaemia. Results:The systematic review identified 2247 articles, of which 16were eligible for inclusion. Combined with 19 studies frompre-2011 analysis, a total of 19 and 8 studies were included in the 24-week and 52-week NMA, respectively. There were no significant differences in HbA1c or SBP between dapagliflozin and other classes, including GLP-1s, at either time point. Significant results were seen for weight loss by 24-weeks for dapagliflozin versusDPP-4i (-2.24 kg [95% CI -3.25,-1.24]) and TZDs (-4.65 kg [-5.89,-3.45]), and at 52-weeks versus SUs, DPP-4i and TZDs. Dapagliflozin also resulted in significantly lower hypoglycaemia risk versus SU (OR: 0.05 [0.01,0.19]) over 52-weeks. Conclusions:This NMA update supports previous findings that effects on HbA1c are similar between drug classes and that dapagliflozin plus metformin offers superior weight control for T2DM patients compared with many other agents. The wider evidence base compared to previous analysis increases the confidence in the results.

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“…Vildagliptin may be used as monotherapy, but better results are found when it is combined with metformin (12,13). Recent studies have shown that, as add-on therapy in patients with inadequately controlled T2DM treated with metformin, vildagliptin was as effective as TZDs (19) and sulphonylureas (20,21). In the present study, we observed that addition of vildagliptin to an unsuccessful combination of metformin with sulphonylurea was able to reduce HbA1c to < 7.0% in 29.7% of patients with T2DM.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of adding vildagliptin to the treatment of diabetic patients nonresponsive to the combination of metformin and a sulphonylurea

Vilar

Gusmão

Albuquerque

et al. 2011

Arq Bras Endocrinol Metab

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OBJECTIVE: To evaluate the effectiveness of adding vildagliptin to the treatment of patients with inadequately controlled type 2 diabetes mellitus (T2DM) treated with a combination of metformin and a sulphonylurea. SUBJECTS AND METHODS: 37 T2DM patients with HbA1c ranging from 7.7% to 12.4% (mean of 9.30 ± 1.38), despite the use of metformin in combination with a sulphonylurea, were additionally treated with vildagliptin (100 mg/day) for at least 6 months. RESULTS: During triple oral therapy (TOT) HbA1c levels < 7% were achieved in 11 patients (29.7%), whereas levels of fasting plasma glucose (FPG) < 120 mg/dL were observed in 12 patients (32.4%). Both findings were observed in 10 patients (27.0%). Compared to nonresponsive subjects, lower mean baseline HbA1c and FPG levels were seen in responsive patients, but the difference was only statistically significant for fasting plasma glucose (FPG). Moreover, there was considerable overlap between the two groups. CONLUSION: Our preliminary results suggest that TOT with metformin, a sulphonylurea and vildagliptin may be useful for some T2DM patients nonresponsive to combination therapy with metformin and sulphonylurea.

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A comparison of efficacy and safety of vildagliptin and gliclazide in combination with metformin in patients with Type 2 diabetes inadequately controlled with metformin alone: a 52‐week, randomized study

Cited by 126 publications

References 29 publications

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

Systematic Review and Network Meta-analysis to Compare Dapagliflozin with other Diabetes Medications in Combination with Metformin for Adults with Type 2 Diabetes

Effectiveness of adding vildagliptin to the treatment of diabetic patients nonresponsive to the combination of metformin and a sulphonylurea

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