As the first add-on treatment to metformin monotherapy, can DPP4i shake up the second-line treatment status of sulfonylureas?

Diabetes mellitus is a chronic metabolic disease that is mainly due to insufficient insulin secretion and/or reduced response of target tissues to the hormone leading to persistent hyperglycemia
.

Metformin is generally considered the drug
of choice for initial T2D treatment.

In addition to traditional second-line non-insulin hypoglycemic drugs such as sulfonylureas, glinides, glitazone and acarbose, in February 2008 the Italian Medical Service approved reimbursement of the first incretinogenic insulins
.

FDA and EMA approved incretin-line drugs

The results of clinical trials suggest that DPP4i has a positive risk/benefit balance in T2D therapy, and in different in vivo and in vitro studies, in addition to stimulating glucose-dependent insulin secretion, activation of GLP-1 receptors is also associated
with increased proliferation of β cells and inhibition of apoptosis.

Researchers routinely collected data from four geographic regions of Italy to verify whether the addition of DPP4i was associated
with delays in intensive therapy (TI) compared with SU in patients receiving metformin monotherapy in patients with T2D.

Between 2008 and 2015 (cohort enrollment), patients aged ≥ 18 years of age receiving MET monotherapy received DPP4i or SU dispensing for the first time, with follow-up endpoints being TI occurrence, treatment discontinuation, dressing change, cancer, death, end of data availability, and end of study (31 December 2016).

Study the choice of population

The matching study cohort included 10,600 patients
.

Kaplan-Meier survival analysis of paired study cohorts

In the above-described retrospective cohort study based on administrative care data, the researchers found that the addition of DPP4i instead of SU to MET monotherapy was not associated
with the delay in subsequent intensive therapy.

Risk of intensive therapy in patients using DDP4i versus those using sulfonylureas: sensitivity analysis

Another observational retrospective cohort study by Mamza et al.

Over the past 20 years, many countries have used SU as the most widely used second-line non-insulin hypoglycemic agent, and although the addition of DPP4i instead of SU to MET monotherapy has nothing to do with the delay in subsequent intensive therapy, DPP4i has shown important advantages over SU in terms of the risk of hypoglycemic events and the impact on body weight, and its hypoglycemic effect, so it is also a good treatment choice
.

Taken together, this study provides further evidence
for the long-term durability of these two widely used second-line hypoglycemic drugs in the real world.

References: 1.

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