Saxagliptin and Sitagliptin in adult patients with type 2 diabetes

Abstract

Objective: To compare the efficacy and safety of sitagliptin and saxagliptin with placebo and other hypoglycemic medications in adults with type 2 diabetes. Research Design & Methods: We searched MEDLINE((R)) , Embase, the Cochrane Library, and the International Pharmaceutical Abstracts from their inception through February 3, 2011. Studies were included of adults with type 2 diabetes that were 12 weeks or more in duration. Meta-analyses were conducted when included studies were homogenous enough to justify combining their results. Results: 32 articles met inclusion criteria. Sitagliptin 100mg monotherapy and saxagliptin 5mg resulted in greater HbA1c reduction compared to placebo (WMD -0.82%, 95% CI -0.95 to -0.70 and WMD -0.70, 95% CI -0.84 to -0.56, respectively). Sitagliptin was similar to sulfonylureas for HbA1c reduction (WMD 0.08%, 95% CI 0-0.16, 3 trials), and to saxagliptin in 1 head-to-head trial. There was no statistically significant difference in hypoglycemia between sitagliptin (pooled RR 1.55, 95% CI 0.55-4.36) or saxagliptin (pooled RR 1.04, 95% CI 0.28 to 3.81) and placebo. Conclusion: Sitagliptin and saxagliptin result in similar modest HbA1c reductions and do not increase the risk of hypoglycemia unless combined with other therapies. Their role in the long term treatment of type 2 diabetes remains unclear given the lack of long-term data on efficacy, harms, and health outcomes