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Predictors of response to dipeptidyl peptidase‐4 inhibitors: evidence from randomized clinical trials
Author(s) -
Monami Matteo,
Cremasco Francesco,
Lamanna Caterina,
Marchionni Niccolò,
Mannucci Edoardo
Publication year - 2011
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.1184
Subject(s) - metformin , medicine , placebo , dipeptidyl peptidase 4 , randomized controlled trial , diabetes mellitus , type 2 diabetes , clinical trial , vildagliptin , dipeptidyl peptidase , pharmacology , endocrinology , gastroenterology , enzyme , biochemistry , chemistry , alternative medicine , pathology
Aim 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. Materials and methods 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drugs, matches to baseline characteristics of patients enrolled in 63 randomized clinical trials, either published or unpublished but disclosed on different websites were studied. Results 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. Conclusions 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. Copyright © 2011 John Wiley & Sons, Ltd.