November 1, 2013

The DPP-4 Inhibitors

DPP-4 inhibitors These are medications also used to make your pancreas produce more insulin for a short period following meals. These medications also work to prevent stored glucose from being dumped from the liver into your blood stream.

You should not take this class of medications and need to talk to your doctor if you are pregnant, planning to get pregnant, or breastfeeding, you have kidney disease, you have type 1 diabetes, and if you have a condition called diabetic ketoacidosis. The side effects while not causing low blood glucose by itself, do increase if you take medications that cause low blood glucose, or insulin. Here also your doctor may advise you to take a lower dose of other diabetes medications while on Januvia. Other possible side effects include a cold, a runny nose, sore throat, or headache. If you take any of this class of medications and have kidney problems, your doctor should order blood tests to see how well your kidneys are working.

The first drug in this class — sitagliptin, manufactured by Merck and sold under the name Januvia, received FDA approval in 2006. Saxagliptin (Onglyza), another DPP-4 inhibitor, was approved in July 2009, followed by Linagliptin (Trajenta) in 2011. A number of additional DPP-4 inhibitors are currently under development.

Last month, in early September, results from the DPP-4 inhibitor cardiovascular outcomes trials SAVOR-TIMI 53 (for Bristol Myers Squibb and AstraZeneca’s Onglyza) and EXAMINE (for Takeda’s Nesina) showed that neither drug affected the risk of heart attacks, stroke, cardiovascular death, or overall death. Onglyza showed a slight increase in hospitalization for heart failure, but there was no increase in death rates as a result.

In the SAVOR and EXAMINE trials, it is reassuring that both Onglyza and Nesina showed no increased risk of pancreatitis or pancreatic cancer, reinforcing the safety profile of DPP-4 inhibitors. The possible association of incretins (DPP-4 inhibitors and GLP-1 agonists) with pancreatitis has been a hot topic in endocrinology, but this is evidence that it should not be a concern.

I would still be concerned because of the past studies on other medications that have been fabricated and I will always have this doubt about trials preformed by pharmacological manufacturers. This may be just me, but until these medications have been on the market for at 10 years, I will always have doubts.

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