Assessment of the Risk of Hospitalization for Heart Failure With Dipeptidyl Peptidase-4 Inhibitors, Saxagliptin, Alogliptin, and Sitagliptin in Patients With Type 2 Diabetes, Using an Alternative Measure to the Hazard Ratio. (July 2017)

• Record Type: Journal Article
• Authors: Kaneko, Masayuki; Narukawa, Mamoru
• Is Part Of: Annals of pharmacotherapy. Volume 51:Number 7(2017:Jul.)
• Page Start: 570
• Page End: 576
• Publication Date: 2017-07
• Subjects: diabetes -- type 2 -- antihyperglycemics -- drug safety -- cardiology -- clinical trials; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.5805
• DOI: 10.1177/1060028017698496
• Languages: English
• ISSNs: 1060-0280

Abstract

Background: Saxagliptin statistically significantly increased the risk of hospitalization for heart failure compared with placebo in the clinical trial of SAVOR-TIMI 53. Neither the reason why only saxagliptin among several dipeptidyl peptidase-4 (DPP-4) inhibitors increased the risk, nor the clinical implication of the result has been explained.Objective: To evaluate the risk of hospitalization for heart failure associated with DPP-4 inhibitors by using an alternative measure to the hazard ratio.Methods: We used the difference in restricted mean survival time (RMST) between DPP-4 inhibitors and placebo to evaluate the risk of cardiovascular events, including hospitalization for heart failure associated with DPP-4 inhibitors. Three randomized clinical trials with cardiovascular events as a primary end point—EXAMINE (alogliptin), SAVOR-TIMI 53 (saxagliptin), and TECOS (sitagliptin)—were reevaluated by estimating the RMSTs for the DPP-4 inhibitors and placebo based on the reconstructed individual patient data for each time-to-event outcome from publicly available information.Results: The differences of RMSTs (DPP-4 inhibitors minus placebo) for hospitalization for heart failure were −4 days [−6, −2] in the SAVOR-TIMI 53 (720 days follow-up), −3 days [−9, 3] in the EXAMINE (900 days follow-up), and 1 day [−5, 7] in the TECOS (1440 days follow-up). There were no substantial differences in the risk of other cardiovascular outcomes between DPP-4 inhibitors and placebo.Conclusions: There are no substantial clinically relevant differences in the risk of cardiovascular events, including hospitalization for heart failure, between 3 of the DPP-4 inhibitors and placebo.