Abstract
Introduction: Dipeptidyl peptidase 4 (DPP-4) inhibitors improve glycemic control in patients with type 2 diabetes mellitus by increasing incretin levels, inhibiting glucagon release, and augmenting insulin secretion. Previous trials raised safety concerns regarding a potential risk of hospitalization for heart failure (HF), but the most recent TECOS trial suggests that adding sitagliptin to usual care did not increase the risk. The objective of this study was to compare the risk of hospitalization for HF among different types of DDP-4 inhibitors. Methods: Diabetic patients who started to use sitagliptin, saxagliptin, and vildagliptin between 2011 and 2013 were identified from Taiwan's National Health Insurance (NHI) claims database. The outcome of interest was the first hospitalization due to HF (ICD-9-CM cod 428). The patients were followed from drug initiation to the outcome occurrence, death or disenrollment from NHI, one year after treatment initiation, or study termination (December 31, 2013). A Cox proportional hazards regression model adjusted for baseline characteristics was used to calculate the hazard ratios (HR) and their 95% confidence intervals, using sitagliptin as the reference group. Results: A total of 239,669 patients, including 159,330 sitagliptin, 38,561 saxagliptin, and 41,778 vildagliptin initiators, were included in the analysis. The mean age of 62.2 years and 52% were male. With a follow-up period ranging from 269 days (vildagliptin) to 313 days (sitagliptin), the crude incidence rate of HF was 2.77, 2.63, and 1.91 per 100 person-years for sitagliptin, saxagliptin, and vildagliptin, respectively. Saxagliptin had a similar HF risk (HR: 0.98, 95% CI: 0.91-1.06) compared to sitagliptin while vildagliptin was associated with a lower risk of HF (HR: 0.85, 95% CI: 0.78-0.93). Conclusions: The safety profile was not all the same among different types of DPP-4 inhibitors in diabetic patients. Vildagliptin was associated with a lower risk of HF than sitagliptin and saxagliptin.
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