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Sitagliptin (Januvia) Linked to Increase in Heart Failure Hospitalizations

Study analyzes patients with diabetes and pre-existing HF

For several years, the cardiovascular effects of drugs used for glucose control in patients with diabetes have been a subject of controversy.

Now, a new observational study has evaluated the effects of the dipeptidyl peptidase (DPP)-4 inhibitor sitagliptin (Januvia, Merck) in patients with type-2 diabetes and heart failure (HF).

The study’s findings were published in the July 2014 issue of the Journal of the American College of Cardiology.

Investigators in Canada analyzed data from a national commercially insured U.S. claims database. Patients with incident HF were identified from individuals with type-2 diabetes initially treated with metformin or sulfonylurea and followed over time. Subjects subsequently treated with sitagliptin were compared with those not treated with the drug in the 90 days before the composite primary outcome of all-cause hospital admission or death. HF-specific hospital admission or death also was assessed.

A total of 7,620 patients with diabetes and incident HF met the study’s inclusion criteria. The patients’ mean age was 54 years, and 58% were male. Overall, 887 patients (12%) were exposed to sitagliptin therapy (521 patient-years of exposure) after incident HF.

The study’s composite primary endpoint occurred in 4,137 patients (54%). After adjustment, sitagliptin users did not demonstrate an increased risk for the primary endpoint compared with non-users (7.1% vs. 9.2%, respectively; adjusted odds ratio [aOR]: 0.84) or for each component of the primary endpoint (i.e., hospital admission: 7.5% vs. 9.2%; aOR: 0.93; and death: 6.9% vs. 9.3%; aOR: 1.16).

However, subjects using sitagliptin showed an increased risk for HF hospitalizations compared with nonusers (12.5% vs. 9.0%, respectively; aOR: 1.84).

The authors concluded that sitagliptin use was not associated with an increased risk for all-cause hospitalizations or death, but was associated with an increased risk for HF-related hospitalizations among patients with type-2 diabetes with pre-existing HF.

Source: JACC; July 7, 2014.

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