title: The long-term efficacy and safety of DPP-IV inhibitors monotherapy and in combination with metformin in 18,980 patients with type-2 diabetes mellitus--a meta-analysis.
abstract: OBJECTIVE
  To assess the long-term efficacy and safety of DPP-IV inhibitors therapy versus comparators in patients with T2DM.
  
  
  METHODS
  A comprehensive search for randomized controlled trials (RCTs; ≥24 weeks) was performed. RCTs had to compare DPP-IV inhibitors therapy with placebo, metformin and sulphonylureas + metformin. Inverse variance mean difference (IV-MD) with 95%CI was calculated for the mean HbA1c changes (%) from baseline to (imputed) endpoint. Mantel-Haenszel odds ratio (MH-OR) with 95%CI was calculated for side reactions.
  
  
  RESULTS
  Twenty-three RCTs were included. The mean HbA1c changes (%) were as follows: IV-MD, 95%CI = -0.35 [-0.51, -0.19], p < 0.0001 for DPP-IV inhibitors therapy versus comparators, and IV-MD, 95%CI = 0.11 [0.04, 0.18], p = 0.002 for DPP-IV inhibitors + met versus su + met. For hypoglycaemia, MH-OR, 95%CI = 0.13 [0.09, 0.19], p < 0.00001(DPP-IV inhibitors + met vs. su + met). For diarrhoea, MH-OR, 95%CI = 0.77 [0.64, 0.93], p = 0.008 (DPP-IV inhibitors + met vs. met). By comparing DPP-IV inhibitors therapy with comparators, we found 95%CI = 0.00 [-0.01, 0.01], p = 0.49, for the upper respiratory tract infection MH-OR; 95%CI = 0.97 [0.70, 1.34], p = 0.83 for the urinary tract infection MH-OR; and 95%CI = 1.07 [0.94, 1.21], p = 0.30 for nasopharyngitis MH-OR.
  
  
  CONCLUSIONS
  DPP-IV inhibitors could achieve a long-term effective and safe glycaemic control for use as monotherapy or in combination with metformin. They have low incidences of hypoglycaemia and gastrointestinal side effects. There is no evidence that DPP-IV inhibitors increase the risk of infections.
authors.affiliation: Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Liu
authors.forename: Qian
authors.initials: Q
authors.lastname: Xiao
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Qiao
authors.initials: Q
authors.lastname: Yang
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Liu
authors.forename: Lingjie
authors.initials: L
authors.lastname: Xu
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008687:Metformin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; C517652:hemoglobin A1c protein, human
keywords: dipeptidyl peptidase-4 inhibitors; efficacy; metformin; pharmacoepidemiology; safety; sulphonylureas; type-2 diabetes mellitus