Sitagliptin: Is It Effective in Routine Clinical Practice?

Ligand-based designing of DPP-4 inhibitors via hybridization; synthesis, docking, and biological evaluation of pyridazine-acetohydrazides

A series of novel pyridazine-acetohydrazide hybrids were designed, synthesized, and evaluated for their in vitro and in vivo antihyperglycemic activity. In this context, pyridazine-acetohydrazides (6a-6p) were synthesized by coupling substituted aldehyde with 2-(5-cyano-6-oxo-3,4-diphenylpyridazine-1-6H-yl) acetohydrazide, which was prepared via the reaction of pyridazine ester with hydrazine hydrate. The molecular docking study was carried out to examine the binding affinities and interaction of designed compounds against the DPP-4 enzyme. Compounds 6e, 6f, 6l, and 6n exhibited interaction with active residue. In silico ADMET properties, and toxicity studies corroborated that compounds were found to have good bioavailability and less toxic. The synthesized compounds were further estimated for in vitro DPP-4 activity. Compounds 6e and 6l were found as the most effective DPP-4 inhibitor in this series with IC50 values (6.48, 8.22 nM) when compared with sitagliptin (13.02 nM). According to the toxicity assay compound, 6l showed very less toxicity at a higher concentration so further selected for the in vivo antihyperglycemic activity.

Evaluation of treatment satisfaction, efficacy and safety of dipeptidyl peptidase-4 inhibitors in geriatric patients with type 2 diabetes mellitus: A cross-sectionalcomparative study

Introduction

Dipeptidyl peptidase 4 (DPP4) inhibitors are attractive agents to be used in the elderly patients with Type 2 diabetes mellitus (T2DM) because of their beneficial effects.

Methods

In this cross-sectional, observational study, we evaluated and compared the treatment satisfaction using Diabetes Treatment Satisfaction Questionnaire (DTSQ) in two groups (i.e., regimens containing DPP4 inhibitors vs. other regimens). Efficacy was evaluated by assessing and comparing the glycosylated hemoglobin (HbA1c) values and the percentage of patients who achieved the glycemic control (HbA1c <7%). The adverse drug reactions (ADRs) were also recorded and compared among two groups.

Results

A total of 115 patients participated in the study (42 in Group 1 and 73 in Group 2). Significantly better DTSQ scores were observed among Group 1 patients in terms of DTSQ score total (P = 0.01) and DTSQ score for perception of hyperglycemia (P = 0.008) as compared to Group 2 patients. Significant difference was observed in HbA1c values among two groups (P = 0.02, 95% confidence interval [CI], 0.06-1.14). Also, significantly higher proportion of patients had achieved glycemic control, i.e., HbA1c <7% in Group 1 as compared to Group 2 (P = 0.002, 95% CI, 11.8%-48.1%). Significantly higher number of ADRs were observed among Group 1 patients as compared to Group 2 (P = 0.003).

Conclusion

DPP4 inhibitors seem to offer better treatment satisfaction and efficacy in geriatric T2DM patients but at the expense of increased frequency of ADRs; however, further research is warranted.

Cost-effectiveness analysis of different dipeptidyl-peptidase 4 inhibitor drugs for treatment of type 2 diabetes mellitus

INTRODUCTION

Type 2 diabetes mellitus (T2DM) has burdened health systems in the world to the value of 500 billion dollars/year. Dipeptidyl peptidase 4 inhibitors (DPP-4 Inhibitors) have been strongly associated with spending on the treatment of T2DM by the courts in Brazil. The aim of this study was to estimate the most cost-effective DPP-4 Inhibitor for T2DM treatment. A pharmacoeconomic study of cost-effectiveness was performed in a medium-sized municipality in Minas Gerais state, Brazil.

METHODS

The data are from legalization in municipal health in 2013. The effectiveness of DPP-4 Inhibitors was measured by the reduction in glycated hemoglobin (A1c). The direct medical costs of drug and adverse drug reactions were identified. With these data, a cost-effectiveness ratio (CER) and construction of the decision tree for sensitivity analysis were performed.

RESULTS

The representative of the most effective in reducing A1c gliptins was sitagliptin in combination with metformin, it was able to reduce A1c by 1.16% (1.09 to 1.22, CI 95%). The drug with the lowest cost was linagliptin, with a cost per patient/year of US$ 481.42. Sensitivity analysis performed by the decision tree shows that sitagliptin in association with metformin had the CER of US$ 1,506.75 per patient/year, to reduce A1c by 1%.

CONCLUSION

The most cost-effective DPP-4 Inhibitor was sitagliptin with metformin.