Linagliptin — new DPP-4 inhibitor. How much novelty does it bring to clinical practice?

Abstract

Preservation of insulin secretion in beta cells is oneof the objectives of type 2 diabetes treatment. Useof incretin-based drugs offers such possibilities. Thedipeptidyl peptidase 4 (DPP-4) inhibitors, the newclass of antidiabetic drugs, increases level of plasmaendogenous GLP-1. Linagliptin, a new drug in thisclass, selectively and reversibly inhibits DPP-4. Inclinical trials linagliptin 5 mg once daily significantlyreduced fasting and postprandial plasma glucoselevels. It is effective when used in monotherapy orin combination with metformin, sulfonylurea andpioglitazone. Linagliptin is well tolerated and hasneutral effects on body weight. There is no increasedrisk of hypoglycaemia attributed to linagliptin usedin monotherapy or combination therapy. Unlike otherDPP-4 inhibitors, linagliptin is excreted almost solely with bile, therefore it may be safely in patients withvarious degrees of renal impairment, even with endstage renal disease. It can be useful as an alternativetreatment for metformin in patients with diabetickidney disease or in metformin-intolerant subjects,where is can be used in monotherapy, as recommededby the Diabetes Poland in 2012.