Dipeptidyl peptidase-4 inhibitor
Glucagon increases blood glucose levels, and DPP-4 inhibitors reduce glucagon and blood glucose levels. The mechanism of DPP-4 inhibitors is to increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.
A recent meta analysis found no favorable or harmful effect of DPPIV inhibitors on all-cause mortality, cardiovascular mortality, or stroke, but a marginally statistically significant increase in heart failure.
Drugs belonging to this class are :
- Sitagliptin (FDA approved 2006, marketed by Merck & Co. as Januvia),
- Vildagliptin (EU approved 2007, marketed in the EU by Novartis as Galvus),
- Saxagliptin (FDA approved in 2009, marketed as Onglyza),
- Linagliptin (FDA approved in 2011, marketed as Tradjenta by Eli Lilly Co and Boehringer Ingelheim),
- Anagliptin (approved in Japan in 2012, marketed by Sanwa Kagaku Kenkyusho Co., Ltd. and Kowa Company, Ltd.)
- Teneligliptin (approved in Japan in 2012)
- Alogliptin (FDA approved 2013, marketed by Takeda Pharmaceutical Company)
- Trelagliptin, approved for use in Japan in 2015
- Gemigliptin (being developed by LG Life Sciences)
- Dutogliptin (being developed by Phenomix Corporation), Phase III
- Omarigliptin (MK-3102) (approved in Japan in 2015, developed by Merck & Co., research showed that omarigliptin can be used as once-weekly treatment and generally well-tolerated throughout the base and extension studies)
Other chemicals which inhibit DPP4 include:
- Berberine, the common herbal dietary supplement, too inhibits dipeptidyl peptidase-4, which at least partly explains its antihyperglycemic activity.
- Lupeol, found in mango, red alder (Alnus rubra), and dandelion coffee.
Adverse effects, including nasopharyngitis, headache, nausea, heart failure, hypersensitivity and skin reactions, have been observed in clinical studies. They may cause severe joint pain.
In response to a report of precancerous changes in the pancreases of rats and organ donors treated with the DPP IV inhibitor sitagliptin, the United States FDA and the European Medicines Agency each undertook independent reviews of all clinical and preclinical data related to the possible association of DPP-IV inhibitors with pancreatic cancer. In a joint letter to the New England Journal of Medicines, the agencies stated that they had not yet reached a final conclusion regarding a possible causative relationship.
A 2014 meta analysis found no evidence for increased pancreatic cancer risk in people treated with DPP IV inhibitors, but owing to the modest amount of data available, was not able to completely exclude possible risk.
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- Banting and Best Diabetes Centre at UT vildagliptin
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