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. 2016 Jul 28:4:2050312116659090.
doi: 10.1177/2050312116659090. eCollection 2016.

An updated systematic review and meta-analysis on the efficacy and tolerability of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes with moderate to severe chronic kidney disease

Devada Singh-Franco  1 , Catherine Harrington  2 , Eglis Tellez-Corrales  3
Affiliations

An updated systematic review and meta-analysis on the efficacy and tolerability of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes with moderate to severe chronic kidney disease

Devada Singh-Franco et al. SAGE Open Med. .

Abstract

Objective: This updated meta-analysis determines the effect of dipeptidyl peptidase-4 inhibitors on glycemic and tolerability outcomes in patients with type 2 diabetes mellitus and chronic kidney disease with glomerular filtration rate of ⩽60 mL/min or on dialysis.

Methods: In all, 14 citations were identified from multiple databases. Qualitative assessments and quantitative analyses were performed.

Results: There were 2261 participants, 49-79 years of age, 49% men and 44% Caucasians. In seven placebo-comparator studies, reduction in hemoglobin A1c at weeks 12-24 was 0.55% (95% confidence interval: -0.68 to -0.43), P < 0.00001). In three sulfonylurea-comparator studies, dipeptidyl peptidase-4 inhibitors did not significantly reduce hemoglobin A1c at weeks 52-54 (-0.15% (95% confidence interval: -0.32 to 0.02)). In one sitagliptin versus albiglutide study, albiglutide significantly reduced hemoglobin A1c in patients with moderate renal impairment (-0.51%). A similar reduction in hemoglobin A1c was seen with sitagliptin versus vildagliptin (-0.56% vs -0.54%). Compared with placebo or sulfonylurea, dipeptidyl peptidase-4 inhibitors did not significantly reduce hemoglobin A1c after 12 and 54 weeks in patients on dialysis. Hypoglycemia was reported by ~30% of patients in both dipeptidyl peptidase-4 inhibitors and placebo groups over 24-52 weeks. While hypoglycemia was more common with a sulfonylurea at 52-54 weeks (risk ratio: 0.46 (95% confidence interval: 0.18 to 1.18)), there was significant heterogeneity (I (2) = 87%). Limitations included high drop-out rate from most studies and small number of active-comparator studies.

Conclusions: Dipeptidyl peptidase-4 inhibitors in patients with chronic kidney disease caused a modest reduction in hemoglobin A1c versus placebo, but not when compared with sulfonylureas or albiglutide, or when used in patients on dialysis. Additional active-comparator studies are needed to further elucidate the role of dipeptidyl peptidase-4 inhibitors in patients with chronic kidney disease stages 3-5 or on dialysis.

Keywords: Meta-analysis; chronic kidney disease; dialysis; dipeptidyl peptidase-4 inhibitors; linagliptin; saxagliptin; sitagliptin; type 2 diabetes mellitus; vildagliptin.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Literature search results.
Figure 2.
Figure 2.
Change in hemoglobin A1c at primary endpoint. MRI: moderate renal impairment (estimated clearance = 30–50mL/min); SRI: severe renal impairment (estimated clearance <30mL/min).
Figure 3.
Figure 3.
Change in fasting plasma glucose. MRI: moderate renal impairment (estimated clearance = 30–50 mL/min); SRI: severe renal impairment (estimated clearance < 30 mL/min).
Figure 4.
Figure 4.
Proportion of patients with any adverse events over 52 weeks. MRI: moderate renal impairment (estimated clearance = 30–50 mL/min); SRI: severe renal impairment (estimated clearance < 30 mL/min).
Figure 5.
Figure 5.
Proportion of patients with hypoglycemia of any severity. MRI: moderate renal impairment (estimated clearance 30–50 mL/min); SRI: severe renal impairment (estimated clearance < 30 mL/min).
Figure 6.
Figure 6.
Risk of bias evaluation of each study.
Figure 7.
Figure 7.
Overall evaluation of bias.
See this image and copyright information in PMC

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