SOURCE: Filion KB, et al. A multicenter observational study of incretin-based drugs and heart failure. N Engl J Med 2016;374:1145-1154.
Opinions about DPP4 inhibitors (e.g., sitagliptin, saxagliptin) and heart failure (HF) have vacillated between “worry” and “don’t worry” for about 2 years. In the March 24, 2016, edition of the New England Journal of Medicine, results of an analysis performed by the Canadian Network for Observational Drug Effect Studies indicate that there is no demonstrable increase in risk for HF, as indicated by hospitalization for HF, with incretin agents (GLP1 analogues and DPP-4 inhibitors). Their conclusions are based on an evaluation of data from 29,741 hospitalizations for HF among 1.5 million patients in the United States, Canada, and the United Kingdom.
On April 6, the FDA issued a “new alert” about the potential for increased risk of HF with saxagliptin (Onglyza) and alogliptin (Nesina), as well as any combination products that contain either of these two agents.
Who’s right? The FDA warnings should be taken seriously, even if other evaluators disagree — if only to maintain an appropriate standard of care. Hence, avoid prescribing the DPP4 inhibitors saxagliptin or alogliptin to patients with HF until the FDA provides further advice. In the meantime, the association with HF has not been deemed a “class effect.” Therefore, other DPP4 inhibitors such as sitagliptin or linagliptin, which were not named by the FDA as proscribed for patients with HF, should be considered when clinicians wish to use a DPP4 inhibitor in patients with HF.
Other DPP4 inhibitors such as sitagliptin or linagliptin should be considered when clinicians wish to use a DPP4 inhibitor in patients with heart failure.
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