Effect of Sitagliptin on Kidney Function and Respective Cardiovascular Outcomes in Type 2 Diabetes: Outcomes From TECOS

Cornel, Jan H.; Bakris, George L.; Stevens, Susanna R.; Alvarsson, Michael; Bax, Willem A.; Chuang, Lee‐Ming; Engel, Samuel S.; Lópes, Renato D.; McGuire, Darren K.; Riefflin, Axel; Rodbard, Helena W.; Sinay, Isaac; Tankova, Tsvetalina; Wainstein, Julio; Peterson, Eric D.; Holman, Rury R.

doi:10.2337/dc16-1415

Cited by 159 publications

(151 citation statements)

References 28 publications

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“…Sitagliptin did not show a significant impact in delaying CKD progression against placebo with a mean eGFR decline −4.0 vs 2.8 mL/min/1.73 m 2 , respectively, with a nonsignificant UACR reductions against placebo over 4 years as well (−0.18 mg/g 95% CI: 0.32‐0.02 P = 0.032). Additionally, sitagliptin was not superior to placebo in cardiovascular outcomes …”

Section: Insulin Secretagoguesmentioning

confidence: 99%

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Niezen

Castillo

Castaner

et al. 2019

Endocrino Diabet & Metabol

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Diabetic kidney disease (DKD) is the major contributor to the mortality and the financial burden of diabetes, accounting for approximately 50% of the cases of end‐stage renal disease (ESRD) in the developed world. Several studies have already demonstrated that achieving blood pressure targets in DKD with agents blocking the renin‐angiotensin system confer superior renoprotection when compared to other agents. However, the effects on renal outcomes of antihyperglycaemic agents in these patients have not been reported or studied broadly until recent years. The intent of this article is to review the available data on safety, efficacy, impact on renal outcomes and pathophysiology implications of the most utilized antihyperglycaemic agents in DKD/ESRD.

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Section: Insulin Secretagoguesmentioning

confidence: 99%

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Niezen

Castillo

Castaner

et al. 2019

Endocrino Diabet & Metabol

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“…In TECOS, sitagliptin was associated with a slight but sustained decrease in urine albumin‐to‐creatinine ratio over the 3‐year follow‐up period . Decreased albuminuria was also seen with saxagliptin .…”

Section: Renal Outcomes Of Dpp4 Inhibitorsmentioning

confidence: 89%

The emerging role of novel antihyperglycemic agents in the treatment of heart failure and diabetes: A focus on cardiorenal outcomes

McHugh

DeVore

Mentz

et al. 2018

Clinical Cardiology

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Heart failure (HF) and type 2 diabetes mellitus (T2DM) are two global pandemics, affecting over 25 and 420 million people, respectively. The prevalence of comorbid HF and T2DM is rising, and the prognosis remains poor. One central area of overlap of these two disease processes is renal dysfunction, which contributes to poor cardiovascular outcomes and mortality. As such, there is a growing need for antihyperglycemic agents with cardio- and renoprotective effects. Three classes of novel antihyperglycemic agents, sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RA), and dipeptidyl peptidase-4 (DPP4) inhibitors have demonstrated varied cardiorenal outcomes in recent cardiovascular outcomes trials. Understanding the differential effects of these agents, together with their proposed mechanisms, is crucial for the development of safe and effective treatment regimens and future pharmacologic targets for HF and T2DM. In this review, we discuss the overlapping pathophysiology of HF and T2DM, summarize outcomes data for the novel antihyperglycemic agents and proposed mechanisms of action, and review how the current evidence informs future management of comorbid HF and T2DM.

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“…In a Japanese report on patients with normal renal function, the serum creatinine concentration slightly, but significantly, increased 1 month after administering sitagliptin, showing no significant difference after 24 months compared to 6 months [14]. The sub-analysis of the Trial Evaluating Cardiovascular Outcomes with Sitagliptin study (TECOS) to evaluate cardiovascular outcome in mainly normoalbuminuric T2DM patients receiving sitagliptin showed that mean change of eGFR during 48 months from the baseline was significantly lower in the sitagliptin group than in the placebo group, but the cumulative incidence of microalbuminuria and renal failure was equivalent in two groups [15]. The efficacy and safety of sitagliptin had also been reported in patients with renal failure [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

The renoprotective effect and safety of a DPP-4 inhibitor, sitagliptin, at a small dose in type 2 diabetic patients with a renal dysfunction when changed from other DPP-4 inhibitors: REAL trial

Kanozawa

Noguchi

Sugahara³

et al. 2017

Clin Exp Nephrol

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Background We conducted the multicenter, prospective, open-label study in type 2 diabetic (T2DM) patients with renal dysfunction, to clarify the efficacy and the safety in relation to renal function and glycemic control, and the economic effect when other dipeptidyl peptidase-4 (DPP-4) inhibitors were switched to a small dose of sitagliptin depending on their renal function. Methods Vildagliptin, alogliptin, or linagliptin received for more than 2 months were changed to sitagliptin at 25 or 12.5 mg/ day depending on their renal function in 49 T2DMs. Renal function and glycemic control, and the drug cost were assessed during 6 months. Results Estimated glomerular filtration rate was not changed in patients not on hemodialysis (n = 29). The HbA1c levels were not altered in all of the patients including those on hemodialysis (n = 20). The active glucagon-like peptide-1 levels or other renal parameters were not altered significantly. There were no adverse events to be related to the drugs. The daily drug expense was reduced by 88.1 yen per patient. Conclusion Switching to a small dose of sitagliptin according to the renal function in T2DM patients with renal dysfunction demonstrated the same efficacy and safety as those with other full-dose DPP-4 inhibitors, indicating a therapeutic option with a high cost performance.

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Effect of Sitagliptin on Kidney Function and Respective Cardiovascular Outcomes in Type 2 Diabetes: Outcomes From TECOS

Abstract: Impaired kidney function is associated with worse cardiovascular outcomes. Sitagliptin has no clinically significant impact on cardiovascular or CKD outcomes, irrespective of baseline eGFR.

Cited by 159 publications

References 28 publications

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

The emerging role of novel antihyperglycemic agents in the treatment of heart failure and diabetes: A focus on cardiorenal outcomes

The renoprotective effect and safety of a DPP-4 inhibitor, sitagliptin, at a small dose in type 2 diabetic patients with a renal dysfunction when changed from other DPP-4 inhibitors: REAL trial

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