title: Sitagliptin and other 'gliptins'--why prescribe them?
abstract: BACKGROUND
  In 2008, the Federal Drug Administration (FDA) required all new glucose-lowering therapies to show cardiovascular safety, and this applies to the dipeptidyl peptidase (DPP)-4 inhibitors ('gliptins'). At present, there is contradictory evidence on whether the gliptins increase hospitalizations for heart failure.
  
  
  METHODS
  This is an evaluation of the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) in high risk cardiovascular subjects with type 2 diabetes [1]. TECOS demonstrated non-inferiority for sitagliptin over placebo for the primary outcome, which was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. There was no difference in the rate of hospitalization for heart failure between sitagliptin and placebo.
  
  
  CONCLUSIONS
  Despite the results of TECOS, debate over the effects of sitagliptin on the rates of hospitalizations for heart failure continues with some recent studies suggesting increased rates. Recently, empagliflozin (an inhibitor of sodium-glucose cotransporter 2) has been shown to reduce cardiovascular outcomes in subjects with type 2 diabetes, including the rates of hospitalization for heart failure. In our opinion, these positive findings with empagliflozin suggest that it should be prescribed in preference to the gliptins, including sitagliptin, unless any positive cardiovascular outcomes are reported for the gliptins.
authors.affiliation: a School of Biomedical Sciences, Faculty of Health , Queensland University of Technology , Brisbane , 4002 , QLD , Australia.
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Doggrell
authors.affiliation: b School of Medicine and Pharmacology , University of Western Australia , Perth , Australia.
authors.forename: Simon B
authors.initials: SB
authors.lastname: Dimmitt
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D011719:Pyrazines / Q000009:adverse effects*; D014230:Triazoles / Q000009:adverse effects*
chemical_list: D007004:Hypoglycemic Agents; D011719:Pyrazines; D014230:Triazoles
keywords: cardiovascular benefit; cardiovascular risk; clinical trials; empagliflozin; heart failure; sitagliptin; type 2 diabetes