Comparison of vildagliptin and sitagliptin in patients with type 2 diabetes and severe renal impairment: a randomised clinical trial

Abstract

Aims/hypothesis: There are limited data comparing dipeptidyl peptidase-4 (DPP-4) inhibitors directly. We compared the safety and efficacy of vildagliptin and sitagliptin in patients with type 2 diabetes and severe renal impairment (RI).

Methods: This study was a parallel-arm, randomised, multicentre, double-blind, 24 week study conducted in 87 centres across Brazil and the USA. Patients with type 2 diabetes, either drug naive or treated with any glucose-lowering agents, who had inadequate glycaemic control (HbA1c 6.5-10.0% [48-86 mmol/mol]) and an estimated GFR <30 ml min(-1) [1.73 m](-2) were randomised (via interactive voice response technology) to vildagliptin 50 mg once daily or sitagliptin 25 mg once daily. These doses are recommended in this patient population and considered maximally effective. Participants, investigators and the sponsor were blinded to group assignment. Efficacy endpoints included change in HbA1c and fasting plasma glucose (FPG) at all visits and the primary safety endpoint was assessment of treatment-emergent adverse events.

Results: In total, 148 patients were randomised, 83 to vildagliptin and 65 to sitagliptin. All patients were analysed. After 24 weeks, the adjusted mean change in HbA1c was -0.54% (5.9 mmol/mol) from a baseline of 7.52% (59 mmol/mol) with vildagliptin and -0.56% (6.1 mmol/mol) from a baseline of 7.80% (62 mmol/mol) with sitagliptin (p = 0.874). FPG decreased by 0.47 ± 0.37 mmol/l with vildagliptin and increased by 0.16 ± 0.43 mmol/l with sitagliptin (p = 0.185). Both treatments were well tolerated with overall similar safety profiles.

Conclusions/interpretation: At their recommended doses for severe RI, vildagliptin (50 mg once daily) compared with sitagliptin (25 mg once daily) demonstrated similar efficacy and both drugs were well tolerated. This study provides further support for the use of DPP-4 inhibitors in patients with severe RI.

Trial registration: ClinicalTrials.gov NCT00616811 (completed)

Funding: This study was planned and conducted by Novartis.

Figures

Fig. 1

Flow diagram of patient disposition. aMore than one reason for discontinuing

Fig. 2

(a) Adjusted mean (SE) change in HbA1c from baseline with vildagliptin 50 mg once daily (n = 78) or sitagliptin 25 mg once daily (n = 62), p = 0.874. (b) Adjusted mean (SE) change in FPG from baseline with vildagliptin 50 mg once daily (n = 79) or sitagliptin 25 mg once daily (n = 62), p = 0.185. (c) Percentage of patients achieving HbA1c ≤6.5% and ≤7.0% with vildagliptin 50 mg once daily (n = 69) or sitagliptin 25 mg once daily n = 56), p = 0.050. Black bars, vildagliptin 50 mg once daily; white bars, sitagliptin 25 mg once daily. To convert values for HbA1c in DCCT % into mmol/mol, subtract 2.15 and multiply by 10.929