Cardiovascular safety of DPP-4 inhibitors compared to that of sulfonylureas
Abstract
After metformin monotherapy, the choice between a sulfonylurea and a dipeptidyl peptidase-4 (DPP-4) inhibitor may be critical in clinical practice. This article compares the cardiovascular safety of these two pharmacological classes based on meta-analyses of randomized controlled trials and observational studies. Both approaches show a better cardiovascular safety with DPP-4 inhibitors than with sulfonylureas. However, some heterogeneity exists, most probably explained by differences between the molecules, especially among sulfonylureas as those of last generation (more particularly gliclazide) seem to have a better safety profile. The ongoing head-to-head prospective trial CAROLINA compares the cardiovascular safety of glimepiride and linagliptin in high-risk patients, with results expected in 2019.
Après la metformine, le choix entre un sulfamide hypoglycémiant ou un inhibiteur de la dipeptidyl peptidase-4 (iDPP-4 ou gliptine) se pose souvent en pratique clinique. Cet article compare la sécurité cardiovasculaire des deux classes à partir de méta-analyses d’essais cliniques randomisés et d’études observationnelles. Les deux types d’approches montrent une meilleure sécurité cardiovasculaire avec les iDPP-4 qu’avec les sulfamides. Cependant, il existe une certaine hétérogénéité, sans doute expliquée par des différences dans les molécules étudiées, en particulier dans la classe des sulfamides, où ceux de dernière génération (gliclazide, notamment) paraissent avoir un meilleur…
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