Alogliptin (Nesina) curbs carotid atherosclerosis in patients with type 2 diabetes, according to an open-label trial from Japan.
Dr. Tomoya Mita from Juntendo University Graduate School of Medicine in Tokyo, said their data demonstrated the efficacy and benefits of alogliptin used at the early stage of disease in preventing the progression of atherosclerosis.
Dr. Mita and colleagues randomized 341 patients with type 2 diabetes to receive alogliptin or conventional treatment not containing dipeptidyl peptidase-4 (DPP-4) inhibitors. None of the patients had a history of cardiovascular disease (CVD).
As reported online December 1 in Diabetes Care, at two years alogliptin had prompted a 0.3% drop in HbA1c, significantly more than the 0.1% drop seen in the standard-treatment group. In addition, the mean common intima-media thickness (IMT) of the carotid artery fell by 0.026 mm in the alogliptin group and rose by 0.005 mm in the conventional group.
Corresponding changes in the right maximum IMT of the carotid artery were -0.045 mm versus 0.011 mm. For the left, these were -0.079 mm and -0.015 mm.
“A large-scale prospective trial is required to establish the usefulness of DPP-4 inhibitors for primary prevention of CVD,” the researchers conclude.
But, Dr. Mita said, “early and effective intervention with use of DPP-4 inhibitors before the development of advanced atherosclerosis may increase the chance of significant reduction of CVD in patients with type 2 diabetes mellitus.”
According to Dr. Dean Eurich of the University of Alberta, Edmonton, the findings are “clinically interesting as changes in carotid IMT are associated with future risk of stroke and heart attacks. However, this is a relatively small trial and previous drugs within this class (saxagliptin and sitagliptin) have also shown benefits on carotid IMT but have failed to show benefit on important cardiovascular endpoints including stroke and heart attack in longer-term randomized controlled trials.”
Dr. Eurich, who is research chair in chronic disease prevention and management, concluded that “although interesting, clinicians and patients should not change their management strategies of type 2 diabetes based on the current results.”
The study was supported by a number of drug companies from which Dr. Mita has received funding. These include Astella, AstraZeneca, Bayer and Takeda Pharmaceutical Co. Other authors have similar relationships.
SOURCE: http://care.diabetesjournals.org/content/early/2015/11/29/dc15-0781 Diabetes Care 2015.