Cardiovascular safety of dipeptidyl peptidase-4 (DPP-4) inhibitors

Abstract

Incretin-based agents, called gliptins or dipeptidyl peptidase-4 inhibitors (DPP-4), are currently considered a promising therapeutic option. It has been known for a long time that these drugs effectively improve glycaemic control, which is reflected by significant HbA1c reduction, without increasing the rate of hypoglycaemia or body weight gain, and that they do not have significant adverse effects. Is it, however, enough to consider them as ‘safe’? No, certainly not. Currently, when assessing the safety of glucose-lowering drugs, the effect on cardiovascular system must be also (and first of all) taking into account. Except for glucose-lowering activity, gliptins have multiple pleiotropic effects and, additionally, are safe in terms of cardiovascular risk, which was proved based on the results from large clinical trials such as SAVOR-TIMI, EXAMINE and, the most recent, TECOS. The future will show whether long-term follow-up of patients treated with gliptins and the results of further trials will confirm current knowledge about DPP-4 inhibitors and expectations associated with this class of drugs.