Saxagliptin improves glycaemic control and is well tolerated in patients with type 2 diabetes mellitus and renal impairment

Nowicki, Michał; Rychlík, Ivan; Haller, Hermann; Warren, Mark; Suchower, Lisa; Gause‐Nilsson, Ingrid

doi:10.1111/j.1463-1326.2011.01382.x

Cited by 119 publications

(115 citation statements)

References 17 publications

(25 reference statements)

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“…Thus, in clinical practice, sitagliptin was frequently used at inappropriate dosages in patients with RI [84]. Saxagliptin 2.5 mg once daily proved to be a well-tolerated treatment option for patients with inadequately controlled T2DM and various degrees of RI, with incidences of adverse events and hypoglycaemic events similar to those with a placebo [85]. In a 12-week study, the reduction in HbA 1c was greater with saxagliptin than with a placebo in subgroups of patients with moderate and severe RI, but not in the subgroup with ESRD on haemodialysis.…”

Section: Patients With Renal Impairmentmentioning

confidence: 99%

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

Scheen¹

2012

Diabetes & Metabolism

172

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: Patients With Renal Impairmentmentioning

confidence: 99%

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

Scheen¹

2012

Diabetes & Metabolism

172

124

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“…Due to their favorable safety profile, especially in terms of reduced hypoglycemia, DPP-4 inhibitors are pro bably the only oral glucose-lowering agents for which some evidence from dedicated randomized clinical trials in patients aged ≥65 years and/or with moderate to severe renal impairment has been published over the last few years. 3,19,[32][33][34][35][36][37][38][39][40] One of these studies, a randomized, placebocontrolled trial in 133 patients with type 2 diabetes (HbA1c 7%-10%) and severe renal impairment (eGFR <30 mL/min per 1.73 m 2 ) showed that adding linagliptin (5 mg/day) to existing background therapy resulted in a significantly greater reduction of HbA1c at 12 weeks 36 which was maintained at 1 year (P<0.0001 vs baseline). In linagliptin-treated patients the incidence of adverse events and severe hypoglycemia was similar to the placebo group.…”

Section: Discussionmentioning

confidence: 99%

Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

et al. 2016

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The treatment of diabetes in frail elderly patients with decreased renal function is challenging and insufficiently supported by evidence. Due to their good tolerability and low hypoglycemic risk, oral dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a reasonable option for glycemic control in the elderly. The aim was to evaluate the efficacy and safety of linagliptin, a long acting, oral DPP-4 inhibitor with a predominantly nonrenal elimination route, in elderly patients with severe chronic kidney disease (CKD). This was a retrospective, observational study in outpatients with type 2 diabetes and advanced-stage CKD (estimated glomerular filtration rate <30 mL/min per 1.73 m 2 ) referring to a diabetes clinic in Italy. Patients were switched from basal insulin to oral linagliptin 5 mg once daily and observed for 14 months. Assessed variables included glycemic control (HbA1c target, 7.5%-8.0%), adherence to treatment (Morisky questionnaire) and patient satisfaction (diabetes treatment satisfaction questionnaire). Adverse events, including hypoglycemic episodes, were also recorded. Thirty patients [mean (±standard deviation) age 70.2 (±8.2) years, HbA1c 7.6% (±0.3), fasting blood glucose 173.9 (±23.5) mg/dL] with type-2 diabetes and advanced CKD were included. The switch to linagliptin did not affect significantly glycemic control, was well tolerated and associated with a reduction in hypoglycemic episodes. Adherence to treatment was better with linagliptin than basal insulin and patient satisfaction significantly improved after switching. Linagliptin appears as a valid option for glycemic control in elderly diabetes patients with severe CKD in treatment with low-dose insulin. However adequately designed longterm studies are needed to confirm these findings.

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“…Применение сак-саглиптина у лиц с СКФ 50-80 мл/мин/1,73 м 2 не требует коррекции дозы препарата. При СКФ <50 мл/мин/1,73 м 2 дозу саксаглиптина необходимо снижать до 2,5 мг/сут [23].…”

Section: рис 1 локализация и физиология рецепторов дпп-4 и гпп-1 в unclassified

Novel approaches of glucose-lowering therapy in type 2 diabetes and chronic kidney disease

Trubitsyna

Петровна²,

Severina

et al. 2015

Probl Endokrinol (Mosk)

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Frequency of the diabetes mellitus (DM) and chronic kidney disease (CKD) steadily increases around the world. Compensation of a carbohydrate metabolism plays a key role in prevention of development and progressing of CKD in patients with DM, that was proved in the largest researches. However at later stages of CKD compensation of a carbohydrate metabolism is extremely complicated because of high risk of hypoglycemia due to decrease in a renal gluconeogenesis, insulin and anti-hyperglycemic agents cumulation, inadequate level of glycated hemoglobin due to nephrogenic anemia. Thus, great care and an individual approach in choosing and intensification of hypoglycemic therapy are required in patients with diabetes. Incretin drugs have taken a worthy place in the international and national guidelines for the treatment of patients with type 2 diabetes mellitus (DM2). Inhibitors of dipeptidyl peptidase-4 (DPP-4) showed a favorable efficacy and safety profile in patients with normal renal function and patients with CKD.

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Saxagliptin improves glycaemic control and is well tolerated in patients with type 2 diabetes mellitus and renal impairment

Abstract: Saxagliptin 2.5 mg once daily is a well-tolerated treatment option for patients with inadequately controlled T2DM and renal impairment.

Cited by 119 publications

References 17 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

Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

Novel approaches of glucose-lowering therapy in type 2 diabetes and chronic kidney disease

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