Dipeptidyl peptidase-4 inhibitors and heart failure: A meta-analysis of randomized clinical trials

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

“…Inhibitory dipeptylopeptydazy 4 (gliptyny), które zwiększają wydzielanie inkretyny i tym samym stymulują uwalnianie insuliny, a także długodziałający agoniści receptora glukagonopodobnego peptydu typu 1 (GLP-1), które działają jako inkretynomimetyki, poprawiają kontrolę glikemii, ale nie obniżają, a być może zwiększają ryzyko zdarzeń sercowo--naczyniowych i pogarszają HF [320,442,443] [130]. Przy braku innych badań obejmujących tę grupę leków nie można zakładać efektu klasy na podstawie danych na temat empagliflozyny.…”

Effect of dipeptidyl peptidase-4 inhibitors on heart failure: A meta-analysis of randomized clinical trials

“…The SAVOR-TIMI 53 study reported a small, but significant 27% increase in rate of HF related hospitalization in patients treated with saxagliptin compared to placebo [6], while the EXAMINE study showed a numerical excess that did not achieve statistical significance in the risk of HF related hospitalization [7]. These reports were followed by two metaanalyses of randomized, controlled trials evaluating the effects of DPP-4 inhibitors and HF [8,9]. Both metaanalyses showed that DPP-4 inhibitors significantly increased the risk of HF [8,9].…”

“…These reports were followed by two metaanalyses of randomized, controlled trials evaluating the effects of DPP-4 inhibitors and HF [8,9]. Both metaanalyses showed that DPP-4 inhibitors significantly increased the risk of HF [8,9]. However, those two metaanalyses were conducted with key limitations including restrictive inclusion criteria, failure to assess the effect of A C C E P T E D M A N U S C R I P T Subgroup analyses were conducted by several parameters including individual DPP-4 inhibitor (alogliptin, linagliptin, saxagliptin, sitagliptin, or vildagliptin), dose, duration of treatment baseline characteristics of subjects including age (<65 or ≥ 65 years), diabetes duration (<10 or ≥ 10 years), HbA1c at baseline (<8.0% or ≥ 8.0%), and BMI (<30 or ≥ 30 kg/m 2 ).…”

The Management of Diabetic Patients with Heart Failure

“…Studies with DPP4i's have cast doubts about their safety in heart failure since earlier studies have shown an increased risk of heart failure in diabetic patients. [24,25] More recent data suggest that they may be safe to use but given their limited clinical benefit and given that there is a lack of data on their effect in patients with heart failure, their use is not recommended except under strict cardiology supervision. [12,26] Scanty data exist on the long-term safety of GLP1 receptor agonists and no data in patients with heart failure are available.…”