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Question clinique
Is linagliptin effective for reducing the risk of adverse cardiovascular events in adults with type 2 diabetes who are at high risk of cardiovascular and kidney events?
L’Essentiel
Linagliptin (Tradjenta) does not increase (or decrease) the risk of adverse cardiovascular events, renal disease, or all-cause mortality in adults with type 2 diabetes. It is slightly more effective for decreasing hemoglobin A1c levels than placebo (mean difference -0.51%). Overall, linagliptin doesn't appear--at least for now--to do much more than make the numbers look better and hit the pay-for-performance measures. 1b
Référence
Plan de l'etude: Randomized controlled trial (double-blinded)
Financement: Industry
Cadre: Outpatient (any)
Sommaire
These investigators identified adults (n = 6991) with type 2 diabetes (hemoglobin A1c values: 6.5% - 10.0%; 48 - 86 mmol/mol) and high cardiovascular and renal risk. High cardiovascular risk was defined as a history of coronary artery disease, stroke, or peripheral vascular disease. High renal risk was defined as either an estimated glomerular filtration rate (eGFR) of 45 to 75 mL/min/1.73 m2 and a urinary albumin to creatinine ratio (UACR) higher than 200 mg/g, or an eGFR of 15 to 45 mL/min/1.73 m2 regardless of UACR. Eligible patients randomly received (concealed allocation assignment) linagliptin (5 mg daily) or matching placebo. The primary outcome was the combined occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. An independent committee reviewed study outcomes and complete follow-up occurred for 98.7% of patients at a median of 2.2 years. Using intention-to-treat analysis, no significant differences in the primary outcome occurred in the linagliptin versus control group (12.4% vs 12.1%, respectively). Similarly, no significant group differences occurred in the secondary outcomes of end-stage renal disease, all-cause mortality, or hospitalization for heart failure. Reports of pancreatic cancer were nonsignificantly increased in the linagliptin group compared with the placebo group (11 vs 4, respectively).
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Commentaires
In Alberta it costs almost …
In Alberta it costs almost $300 for 3 months of this drug. $1200 a year will buy your patient a really nice bicycle which will improve their life far, far more.