Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
PROMISE Department, School of Medicine, University of Palermo, Palermo, Italy; 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Metabolism. 2020 Aug;109:154295. doi: 10.1016/j.metabol.2020.154295. Epub 2020 Jun 15.
The dipeptidyl peptidase-4 inhibitors (DPP-4is), which belong to the class of incretin-based medications, are recommended as second or third-line therapies in guidelines for the management of type 2 diabetes mellitus. They have a favorable drug tolerability and safety profile compared to other glucose-lowering agents.
This review discusses data concerning the use of DPP-4is and their cardiovascular profile, and gives an updated comparison with the other oral glucose-lowering medications with regards to safety and efficacy. Currently available original studies, abstracts, reviews articles, systematic reviews and meta-analyses were included in the review.
DPP4is are moderately efficient in decreasing the HbA1c by an average of 0.5% as monotherapy, and 1.0% in combination therapy with other drugs. They have a good tolerability and safety profile compared to other glucose-lowering drugs. However, there are possible risks pertaining to acute pancreatitis and pancreatic cancer.
Cardiovascular outcome trials thus far have proven the cardiovascular safety for ischemic events in patients treated with sitagliptin, saxagliptin, alogliptin, linagliptin and vildagliptin. Data showing increased rate of hospitalisation in the case of saxagliptin did not seem to be a class effect.
二肽基肽酶-4 抑制剂（DPP-4i）属于基于肠促胰岛素类药物，在治疗 2 型糖尿病的指南中被推荐作为二线或三线治疗药物。与其他降血糖药物相比，它们具有良好的药物耐受性和安全性。
本综述讨论了 DPP-4i 的使用数据及其心血管特征，并就安全性和疗效与其他口服降糖药物进行了最新比较。综述纳入了目前可用的原始研究、摘要、综述文章、系统评价和荟萃分析。
DPP4i 作为单药治疗时，HbA1c 平均降低 0.5%，与其他药物联合治疗时降低 1.0%。与其他降血糖药物相比，它们具有良好的耐受性和安全性。然而，它们可能存在急性胰腺炎和胰腺癌的风险。
迄今为止，心血管结局试验证明了接受西格列汀、沙格列汀、阿格列汀、利格列汀和维格列汀治疗的患者发生缺血事件的心血管安全性。关于 saxagliptin 增加住院率的数据似乎不是类效应。
