Sitagliptin Use in Patients With Diabetes and Heart Failure: A Population-Based Retrospective Cohort Study | Journal Scan

Study Questions:

What are the effects of sitagliptin in patients with type 2 diabetes (T2D) and heart failure (HF)?


The investigators analyzed data from a national commercially insured US claims database. They identified patients with incident HF from individuals with T2D initially treated with metformin or sulfonylurea and followed them over time. They used nested case-control analysis after adjustment for demographics and clinical and laboratory data to compare subjects subsequently using sitagliptin with those not using sitagliptin in the 90 days before the primary outcome of all-cause hospital admission or death. They also assessed HF-specific hospital admission or death.


The study cohort was comprised of 7,620 patients with diabetes and incident HF that met the inclusion criteria. The mean ± standard deviation age was 54 ± 9 years, and 58% (n = 3,180) were male; 12% of patients (n = 887) were exposed to sitagliptin therapy (521 patient-years of exposure) after incident HF. The primary composite endpoint occurred in 54% of patients (n = 4,137). The study authors found that sitagliptin users were not at an increased risk for the primary endpoint (7.1% vs. 9.2%, adjusted odds ratio [aOR], 0.84; 95% confidence interval [CI], 0.69-1.03) or each component (hospital admission 7.5% vs. 9.2%, aOR, 0.93; 95% CI, 0.76-1.14; death 6.9% vs. 9.3%, aOR, 1.16; 95% CI, 0.68-1.97). However, sitagliptin use was associated with an increased risk of HF hospitalizations (12.5% vs. 9.0%, aOR, 1.84; 95% CI, 1.16-2.92).


The authors concluded that sitagliptin use was not associated with an increased risk of all-cause hospitalizations or death, but was associated with an increased risk of HF-related hospitalizations in patients with T2D with pre-existing HF.


This is an important study because it suggests that sitagliptin increases the risk of HF hospitalizations in patients with pre-existing HF. The findings of this study are similar to the EXAMINE trial with alogliptin and the SAVOR-TIMI 53 trial where saxagliptin was associated with a 27% increased risk for HF. Indeed, it remains unclear whether this is a class effect or whether it applies to all agents belonging to this class. Until prospective data are available, the findings of this study suggest that ‘gliptins’ are not the drugs of first choice in those with pre-existing HF, particularly when there is a history of recurrent HF hospitalizations.

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