Predictors of response to dipeptidyl peptidase-4 inhibitors: evidence from randomized clinical trials
Predictors of response to dipeptidyl peptidase-4 inhibitors: evidence from randomized clinical trials
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DOI：
10.1002/dmrr.1184
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发表时间：
2011-05-01
影响因子：
8
通讯作者：
Mannucci, Edoardo
中科院分区：
文献类型：
--
作者：
Monami, Matteo;Cremasco, Francesco;Mannucci, Edoardo
目的二肽基肽酶-4（DPP-4）抑制剂用于治疗2型糖尿病。现有的临床试验亚组分析无法明确识别这些药物治疗反应的预测因子。本研究的目的是评估DPP-4抑制剂反应的预测因子。材料和方法进行荟萃分析，探索最大剂量DPP-4抑制剂与安慰剂或其他活性药物相比对HbA（1c）的24周效应之间的相关性，与63项随机临床试验中招募的患者的基线特征匹配，结果DPP-4抑制剂在24周时显著降低HbA（1c）[0.6（0.5-0.7）%];与噻唑烷二酮类和α-葡萄糖苷酶抑制剂相比，没有观察到HbA（1c）的差异，而磺酰脲类和二甲双胍至少在短期内产生更大的HbA（1c）降低。DPP-4抑制剂产生的体重增加小于噻唑烷二酮类药物，低血糖风险低于磺脲类药物。在老年患者和基线空腹血糖较低的患者中，DPP-4抑制剂对HbA（1c）的安慰剂减去效应更大。在与噻唑烷二酮类药物和二甲双胍的比较中获得了类似的结果。结论虽然2型糖尿病的药物研究在异质性样本的患者，他们的疗效可以预测的一些临床参数。DPP-4抑制剂似乎在轻度/中度空腹高血糖的老年患者中更有效。这些数据可能有助于更好地定义可能从这些药物中获益最多的患者的概况。版权所有（C）2011约翰威利父子有限公司
Aim Dipeptidyl peptidase-4 (DPP-4) inhibitors are used in the treatment of type 2 diabetes. Available sub-group analysis of clinical trials does not allow a clear identification of predictors of therapeutic response to these drugs. The aim of this study is the assessment of predictors of response to DPP-4 inhibitors.Materials and methods A meta-analysis was performed, exploring correlation between 24-week effects on HbA(1c) of maximal doses of DPP-4 inhibitors, compared either with placebo or with other active drugs, matches to baseline characteristics of patients enrolled in 63 randomized clinical trials, either published or unpublished but disclosed on different websites were studied.Results DPP-4 inhibitors significantly reduce HbA(1c) at 24 weeks [by 0.6 (0.5-0.7)%] when compared with placebo; no difference in HbA(1c) was observed in comparisons with thiazolidinediones and alpha-glucosidase inhibitors, whereas sulfonylureas and metformin produced a greater reduction of HbA(1c), at least in the short term. DPP-4 inhibitors produced a smaller weight gain than thiazolidinediones, and showed a lower hypoglycaemia risk than sulfonylureas. The placebo-subtracted effect of DPP-4 inhibitors on HbA(1c) was greater in older patients and in those with lower fasting plasma glucose at baseline. Similar results were obtained in comparisons with thiazolidinediones and metformin.Conclusions Although drugs for type 2 diabetes are studied in heterogeneous samples of patients, their efficacy can be predicted by some clinical parameters. DPP-4 inhibitors appear to be more effective in older patients with mild/moderate fasting hyperglycaemia. These data could be useful for a better definition of the profile of patients who are likely to benefit most from these drugs. Copyright (C) 2011 John Wiley & Sons, Ltd.