Mortality, hospitalization may be similar with sitagliptin versus other oral antidiabetics

Sitagliptin was associated with similar rates of hospital admission and mortality as other glucose-lowering drugs, according to a recent study of patients with type 2 diabetes.

The observational, retrospective study used a database of commercial insurance claims to find more than 72,000 U.S. patients who began taking an oral antidiabetic drug between 2004 and 2009. They were followed until death, termination of insurance or the end of 2010. The study's composite endpoint was all-cause hospital admission and all-cause mortality. Results were published by BMJ on April 25.

Of the 72,738 patients, 11% took sitagliptin; of those, 91% took it in combination with at least one other antidiabetic agent. In the total study population, 11% of patients had ischemic heart disease and 9% had diabetes complications when their first diabetes drug was prescribed. Sitagliptin users were slightly more likely to have diabetes complications and to use insulin at the start of treatment. Overall, 20% of the studied patients died or were admitted to the hospital, and sitagliptin users had a similar rate of this outcome compared with other patients (adjusted hazard ratio [HR] 0.98; 95% CI, 0.91 to 1.06), even if they had ischemic heart disease (HR, 1.10; 95% CI, 0.94 to 1.28) or estimated glomerular filtration rate below 60 mL/min (HR, 1.11; 95% CI, 0.88 to 1.41).

The results of this first population-based study of a dipeptidyl peptidase-4 (DPP-4) inhibitor's effect on mortality and hospitalization are consistent with previous observational studies showing that sitagliptin isn't associated with increased acute pancreatitis. However, the results don't confirm recent meta-analyses finding a major reduction in adverse cardiac events in patients on the drug, the study authors noted. That could be due to the higher baseline risk of patients taking sitagliptin in the current study. The study's observational nature and relatively short follow-up were two limitations.

Definitive conclusions about the safety of sitagliptin in patients with cardiovascular disease will only be possible after the conclusion of a large, currently ongoing trial, the study authors noted. Still, the results of this observational study support current recommendations for use of sitagliptin and indicate that the drug seems to be safe in patients with diabetes. “Given the current controversy about other antidiabetic agents, most notably the thiazolidinediones, this is important information for patients and for clinicians,” the study authors wrote.