Original Title: Inhibidores de dipeptidil peptidasa 4 (DPP4) en diabetes mellitus

Authors' recommendations: CONCLUSIONS High-quality evidence shows that treatment with DPP4 inhibitors does not reduce overall or cardiovascular mortality, or the risk of other serious cardiovascular events in patients with type 2 diabetes mellitus when compared to placebo and other oral glucose-lowering drugs as first, second or third line treatment, and it is associated to a higher overall and cardiovascular mortality when compared with SGLT-2 and GLP-1 drugs. Also, adding DPP4 inhibitors as second or third line caused smaller reductions in glycosylated hemoglobin versus other glucose-lowering drugs and was associated to a higher risk of therapeutic failure – the need to add another drug or not meeting the treatment goals – when compared with monotherapy with metformin or in combination with other sulfonylureas, respectively. However, it was also associated with a lower risk of stroke and a lower risk of total hypoglycemia in type 2 DM, when compared with metformin plus sulfonylureas. Moderate-quality evidence suggests that using DPP4 in patients with moderate/severe kidney disease, does not increase the risk of hypoglycemia when compared with placebo and a greater proportion of patients meet their HbA1c treatment goal with DPP4. Moderate-quality evidence suggests that adding DPP4 to insulin therapy does not improve the HbA1c results in patients with type 1 diabetes. The clinical practice guidelines assessed mention DPP4 among the treatment alternatives for patients with refractory type 2 diabetes mellitus, in general in combination, and only some suggest it as monotherapy when metformin is contraindicated. They suggest that the indication of one or other antidiabetic drug should be done on a case by case basis considering several factors. No clinical practice guideline recommends using DPP4 inhibitors for type 1 DM. Latin American sponsors do not mention or cover DPP4 inhibitors in patients with DM. Among high-income country sponsors, most cover it as second or third line treatment.

Project Status: Completed

Year Published: 2018

URL for published report: https://www.iecs.org.ar/home-ets/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)