Diabetes Agency, University of Florence and Careggi Teaching Hospital, Florence, Italy.
Diabetes Metab Res Rev. 2011 May;27(4):362-72. doi: 10.1002/dmrr.1184.
Dipeptidyl peptidase-4 (DPP-4) inhibitors are used in the treatment of type 2 diabetes. Available sub-group analysis of clinical trials does not allow a clear identification of predictors of therapeutic response to these drugs. The aim of this study is the assessment of predictors of response to DPP-4 inhibitors.
A meta-analysis was performed, exploring correlation between 24-week effects on HbA(1c) of maximal doses of DPP-4 inhibitors, compared either with placebo or with other active drugs, matches to baseline characteristics of patients enrolled in 63 randomized clinical trials, either published or unpublished but disclosed on different websites were studied.
DPP-4 inhibitors significantly reduce HbA(1c) at 24 weeks [by 0.6 (0.5-0.7)%] when compared with placebo; no difference in HbA(1c) was observed in comparisons with thiazolidinediones and α-glucosidase inhibitors, whereas sulfonylureas and metformin produced a greater reduction of HbA(1c) , at least in the short term. DPP-4 inhibitors produced a smaller weight gain than thiazolidinediones, and showed a lower hypoglycaemia risk than sulfonylureas. The placebo-subtracted effect of DPP-4 inhibitors on HbA(1c) was greater in older patients and in those with lower fasting plasma glucose at baseline. Similar results were obtained in comparisons with thiazolidinediones and metformin.
Although drugs for type 2 diabetes are studied in heterogeneous samples of patients, their efficacy can be predicted by some clinical parameters. DPP-4 inhibitors appear to be more effective in older patients with mild/moderate fasting hyperglycaemia. These data could be useful for a better definition of the profile of patients who are likely to benefit most from these drugs.
二肽基肽酶-4（DPP-4）抑制剂用于治疗 2 型糖尿病。临床试验的可用亚组分析不允许明确识别这些药物治疗反应的预测因子。本研究旨在评估 DPP-4 抑制剂反应的预测因子。
进行了荟萃分析，探讨了 63 项随机临床试验中纳入的患者基线特征与 DPP-4 抑制剂最大剂量与安慰剂或其他活性药物相比，24 周时对 HbA（1c）的影响之间的相关性，无论是已发表的还是未发表的，但都在不同的网站上披露。
与安慰剂相比，DPP-4 抑制剂在 24 周时显着降低 HbA（1c）[0.6（0.5-0.7）%]；与噻唑烷二酮和α-葡萄糖苷酶抑制剂相比，HbA（1c）无差异，而磺酰脲类药物和二甲双胍至少在短期内降低 HbA（1c）的作用更大。DPP-4 抑制剂引起的体重增加小于噻唑烷二酮，低血糖风险低于磺酰脲类药物。与安慰剂相比，DPP-4 抑制剂对 HbA（1c）的影响在老年患者和基线时空腹血糖较低的患者中更大。与噻唑烷二酮和二甲双胍的比较也得到了类似的结果。
尽管 2 型糖尿病药物在异质患者样本中进行了研究，但可以通过一些临床参数预测其疗效。DPP-4 抑制剂在空腹血糖轻度/中度升高的老年患者中似乎更有效。这些数据对于更好地定义可能从这些药物中受益最大的患者特征可能是有用的。
