The cardiovascular safety and efficacy of many current antihyperglycemic agents, including Saxagliptin ( Onglyza ), a dipeptidyl peptidase 4 ( DPP-4 ) inhibitor, are unclear.
Researchers have randomly assigned 16,492 patients with type 2 diabetes who had a history of, or were at risk for, cardiovascular events to receive Saxagliptin or placebo and followed them for a median of 2.1 years.
Physicians were permitted to adjust other medications, including antihyperglycemic agents.
The primary end point was a composite of cardiovascular death, myocardial infarction, or ischemic stroke.
A primary end-point event occurred in 613 patients in the Saxagliptin group and in 609 patients in the placebo group ( 7.3% and 7.2%, respectively, according to 2-year Kaplan–Meier estimates; hazard ratio with Saxagliptin, HR=1.00; P=0.99 for superiority; P less than 0.001 for noninferiority ); the results were similar in the on-treatment analysis ( HR=1.03 ).
The major secondary end point of a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, coronary revascularization, or heart failure occurred in 1059 patients in the Saxagliptin group and in 1034 patients in the placebo group ( 12.8% and 12.4%, respectively, according to 2-year Kaplan–Meier estimates; HR=1.02; P=0.66 ).
More patients in the Saxagliptin group than in the placebo group were hospitalized for heart failure ( 3.5% vs 2.8%; HR=1.27; P=0.007 ).
Rates of adjudicated cases of acute and chronic pancreatitis were similar in the two groups ( acute pancreatitis, 0.3% in the Saxagliptin group and 0.2% in the placebo group; chronic pancreatitis, less than 0.1% and 0.1% in the two groups, respectively ).
In conclusion, DPP-4 inhibition with Saxagliptin did not increase or decrease the rate of ischemic events, though the rate of hospitalization for heart failure was increased.
Although Saxagliptin improves glycemic control, other approaches are necessary to reduce cardiovascular risk in patients with diabetes. ( Xagena )
Scirica BM et al, N Engl J Med 2013; 369: 1317-1326