Baruah Manash P, Bhuyan Sonali B, Deka Jumi, Bora Jatin, Bora Smritisikha, Barkakati Murchana
Endocrinology Unit, Excel Centre (Initiative of Excel Care Hospitals Pvt. Ltd.), Guwahati, Assam, India.
Indian J Endocrinol Metab. 2016 Jul-Aug;20(4):568-72. doi: 10.4103/2230-8210.183468.
Linagliptin, a dipeptidyl peptidase 4 (DPP 4) inhibitor with a long terminal half life, significantly inhibits the DPP 4 enzyme at a steady state up to 48 h after the last dose. The present case series examined the hypothesis that linagliptin retains its efficacy during alternate day dosing in type 2 diabetes patients when switched over from once daily (OD) dosing. Eight type 2 diabetes patients maintaining stable glycosylated hemoglobin (HbA1c) with acceptable fasting plasma glucose and postprandial glucose levels and receiving linagliptin 5 mg OD for at least 6 weeks, with a stable dose of concomitant antidiabetic medications were given linagliptin 5 mg every alternate day. The median HbA1c while on the OD regimen was 6.1% (43 mmol/mol) (range: 5.8-6.9% [40-52 mmol/mol]) and median duration of diabetes was 7 years (range: 0.75-16 years). After a median follow-up period of 21weeks,the glycemic control was maintained in all patients similar to their baseline values (median HbA1c: 6.0% [42 mmol/mol], range: 5.1-7.1% [32-54 mmol/mol]). The body weight, fasting, and random glucose levels at baseline were also well maintained at the end of treatment. Optimal glycemic status maintained in our study population favors our hypothesis that linagliptin used alternate daily after switching from initial OD dose of the drug in patients on a stable background antidiabetic medications retains its efficacy. Paradoxically, alternate day dosing may affect compliance if the patient forgets when they took the last dose. Further studies including larger cohorts are needed to validate this finding and identify patients who can benefit from the alternate day regimen.
利格列汀是一种具有较长终末半衰期的二肽基肽酶4（DPP-4）抑制剂，在最后一剂后长达48小时的稳态下能显著抑制DPP-4酶。本病例系列研究了这样一个假设：对于2型糖尿病患者，从每日一次（OD）给药切换为隔日给药时，利格列汀仍能保持其疗效。8名2型糖尿病患者糖化血红蛋白（HbA1c）稳定，空腹血糖和餐后血糖水平可接受，且接受利格列汀5mg OD治疗至少6周，同时服用稳定剂量的抗糖尿病药物，改为隔日服用利格列汀5mg。在OD治疗方案下，HbA1c中位数为6.1%（43 mmol/mol）（范围：5.8 - 6.9% [40 - 52 mmol/mol]），糖尿病病程中位数为7年（范围：0.75 - 16年）。经过21周的中位随访期后，所有患者的血糖控制维持在与基线值相似的水平（HbA1c中位数：6.0% [42 mmol/mol]，范围：5.1 - 7.1% [32 - 54 mmol/mol]）。治疗结束时，体重、空腹血糖和随机血糖水平也保持良好。我们研究人群中维持的最佳血糖状态支持了我们的假设，即在稳定的背景抗糖尿病药物治疗的患者中，从该药物的初始OD剂量切换后隔日使用利格列汀仍能保持其疗效。矛盾的是，如果患者忘记上次服药时间，隔日给药可能会影响依从性。需要包括更大队列的进一步研究来验证这一发现，并确定能从隔日治疗方案中获益的患者。
