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No link between heart failure, DPP-IV inhibitors in type 2 diabetes
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In patients with type 2 diabetes, no apparent association exists between hospitalization for heart failure or other analyzed cardiovascular outcomes and a treatment regimen consisting of a DPP-IV inhibitor vs. sulfonylureas or treatment with Onglyza vs. Januvia.
Stephen S. Johnston, of Truven Health Analytics in Bethesda, Maryland, and colleagues evaluated insurance claims data extracted from the Truven Health MarketScan Commercial and Medicare Supplemental databases. Patients identified for analysis initiated treatment on DPP-IV inhibitors — Onglyza (saxagliptin, AstraZeneca), Januvia (sitagliptin, Merck) and Tradjenta (linagliptin, Boehringer Ingelheim) — or sulfonylureas between Aug. 1, 2010 and Aug. 30, 2013. Researchers compared DPP-IV inhibitors with sulfonylureas in 218,556 patients and saxagliptin with sitagliptin in 112,888 patients.
Patients were further divided into groups based on CVD status at baseline: no baseline CVD (DPP-IV, n = 82,019; sulfonylurea, n = 82,019; saxagliptin, n = 43,402; sitagliptin, n = 43,402) and baseline CVD (DPP-IV, n = 27,259; sulfonylurea, n = 27,259; saxagliptin, n = 13,042; sitagliptin, n = 13,042).
The study’s primary outcome was hospitalization for heart failure during follow-up, and secondary outcomes included hospitalization for acute myocardial infarction, hospitalization for stroke, hospitalization for unstable angina, coronary revascularization and a composite of all outcomes combined.
Among patients with baseline CVD, researchers found no statistically significant difference in the hazards of hospitalization for heart failure between patients treated with DPP-IV inhibitors and those treated with sulfonylureas (HR = 0.95; 95% CI, 0.78-1.15).
In the comparison of saxagliptin vs. sitagliptin, neither stratification of baseline CVD demonstrated a statistically significant difference in hospitalization for heart failure hazards (patients with baseline CVD: HR = 0.95; 95% CI, 0.7-1.28; patients without baseline CVD: HR = 0.99; 95% CI, 0.56-1.75).
In patients without baseline CVD, researchers found a significantly lower hazard of hospitalization for heart failure in those treated with DPP-IV inhibitors vs. those treated with sulfonylureas (HR = 0.59; 95% CI, 0.38-0.89).
Those treated with a DPP-IV inhibitor had significantly lower hazards of the secondary outcomes vs. those treated with sulfonylureas (all P < .05).
“Heart failure is not uncommon among patients with type 2 diabetes, and the selection of pharmacotherapy can impact that risk,” the researchers wrote. “It is an important part of current medical practice to monitor all patients with type 2 diabetes for heart failure symptoms, such as shortness of breath and edema. In this observational study of patients with type 2 diabetes, we found no association between [hospitalization for heart failure], or other selected cardiovascular outcomes, and treatment with a DPP-IV inhibitor relative to [sulfonylureas] or treatment with saxagliptin relative to sitagliptin.” – by Jennifer Byrne
Disclosure: Johnston reports financial ties with AstraZeneca and Truven Health Analytics. Please see the full study for a list of all other authors’ relevant financial disclosures.
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