Category: Professional Posters
Purpose: When treatment with a particular dipeptidyl peptidase-4 (DPP-4) inhibitor is ineffective, then transfer to another DPP-4 inhibitor is possible. However, the effectiveness of such a transfer is unclear. Recently, DPP-4 inhibitors were classified into three categories on the basis of their binding subsites: vildagliptin and saxagliptin are in class 1, alogliptin and linagliptin in class 2, and sitagliptin and teneligliptin in class 3. The aim of the present study was to determine the effectiveness of transferring between DPP-4 inhibitors.
Methods: We performed a retrospective study based on the medical records of patients who were transferred from one DPP-4 inhibitor to another DPP-4 inhibitor. We enrolled 85 patients, who continued to take a DPP-4 inhibitor over 3 months before transferring to another DPP-4 inhibitor. Twenty-three patients were excluded for the following reasons: lack of glycated hemoglobin (HbA1c) data 3 months after changing DPP-4 inhibitor (n = 7); dose increase in DPP-4 inhibitor or transfer to another DPP-4 inhibitor within less than 3 months (n = 6); transfer to another anti-type-2 diabetes mellitus (T2DM) medication (n = 5); dose increase or receipt of another anti-T2DM medication (n = 4); or dose reduction in another anti-T2DM medication (n = 1). Finally, we evaluated 62 patients. The anti-hyperglycemic efficacy of DPP-4-inhibitor transfer was assessed retrospectively by considering the HbA1c level before and 3 months after transferring to another DPP-4 inhibitor.
Results: The overall mean change in HbA1c levels was −0.34% (95% confidence interval (CI), −0.12 to −0.56; n = 62). The mean change in the HbA1c level between the different classes was −0.35 (95% CI, −0.12 to −0.58; n = 59). The mean change in the HbA1c level between each class of DPP-4 inhibitor was calculated. From class 3 to class 2 this was −0.45% (n = 25); from class 3 to class 1 −0.36% (n = 17); from class 1 to class 2 −0.24% (n = 7); from class 1 to class 3 0.33% (n = 4); from class 2 to class 1 −0.30% (n = 5); and from class 2 to class 3 −1.30% (n = 1). Additionally, we investigated the reason for transferring between DPP-4 inhibitors, which was specified in the medical records of 24 of the enrolled patients. The reasons given were “poor glycemic control” (70.8%), “reduced renal function” (20.8%), “side effects” (4.2%), and “forgot to take the medicine” (4.2%).
Conclusion: Transferring between different classes of DPP-4 inhibitors resulted in a significant reduction in the HbA1c level. In this study, transferring between DPP-4 inhibitors with consideration of their DPP-4 binding site contributes to a reduction in the HbA1c level during T2DM treatment.