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
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.
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.
- Herper, Matthew; Langreth, Robert (27 April 2006). "Diabetes Drugs to Watch". Forbes.com. Pharmaceuticals. Retrieved 26 April 2009.
See pages of this article for Galvus aka LAF237 (Novartis) and Januvia aka MK-0431 (Merck)
- Nielsen, L (2005). "Incretin mimetics and DPP-IV inhibitors for the treatment of type 2 diabetes". Drug Discovery Today 10 (10): 703–10. doi:10.1016/S1359-6446(05)03460-4. PMID 15896683.
Includes table describing an overview of type 2 diabetes drug therapies; 76 references.
- "FDA Approves New Treatment for Diabetes" (Press release). U.S. Food and Drug Administration. October 17, 2006. Retrieved 2006-10-17.
- McIntosh, C; Demuth, H; Pospisilik, J; Pederson, R (2005). "Dipeptidyl peptidase IV inhibitors: How do they work as new antidiabetic agents?". Regulatory Peptides 128 (2): 159–65. doi:10.1016/j.regpep.2004.06.001. PMID 15780435.
- Behme, Margaret T; Dupré, John; McDonald, Thomas J (2003). "Glucagon-like peptide 1 improved glycemic control in type 1 diabetes". BMC Endocrine Disorders 3 (1): 3. doi:10.1186/1472-6823-3-3. PMC 154101. PMID 12697069.
- Dupre, J.; Behme, M. T.; Hramiak, I. M.; McFarlane, P.; Williamson, M. P.; Zabel, P.; McDonald, T. J. (1995). "Glucagon-like peptide I reduces postprandial glycemic excursions in IDDM". Diabetes 44 (6): 626–30. doi:10.2337/diabetes.44.6.626. PMID 7789625.
- Wu S, Hopper I, Skiba M, Krum H (April 2014). "Dipeptidyl peptidase-4 inhibitors and cardiovascular outcomes: Meta-analysis of randomized clinical trials with 55,141 participants". Cardiovasc Ther. doi:10.1111/1755-5922.12075. PMID 24750644.
- Banting and Best Diabetes Centre at UT sitagliptin
- Banting and Best Diabetes Centre at UT vildagliptin
- "FDA approves new treatment for Type 2 diabetes". Fda.gov. 2011-05-02. Retrieved 2013-04-15.
- Joanne Bronson, Amelia Black, T. G. Murali Dhar, Bruce A. Ellsworth, and J. Robert Merritt. "Teneligliptin (Antidiabetic)". Annual Reports in Medicinal Chemistry 48: 523–524. doi:10.1016/b978-0-12-417150-3.00028-4.
- "LG Life Science". Lgls.com. Retrieved 2013-04-15.
- "Forest Splits With Phenomix", San Diego Business Journal, Tuesday, April 20, 2010 http://www.sdbj.com/news/2010/apr/20/forest-splits-phenomix/
- Al-Masri, Ihab M.; Mohammad, Mohammad K.; Tahaa, Mutasem O. (2009). "Inhibition of dipeptidyl peptidase IV (DPP IV) is one of the mechanisms explaining the hypoglycemic effect of berberine". Journal of Enzyme Inhibition and Medicinal Chemistry 24 (5): 1061–6. doi:10.1080/14756360802610761. PMID 19640223.
- Matveyenko AV, Dry S, Cox HI et al. (July 2009). "Beneficial endocrine but adverse exocrine effects of sitagliptin in the human islet amyloid polypeptide transgenic rat model of type 2 diabetes: interactions with metformin". Diabetes 58 (7): 1604–15. doi:10.2337/db09-0058. PMC 2699878. PMID 19403868.
- Butler AE, Campbell-Thompson M, Gurlo T, Dawson DW, Atkinson M, Butler PC (July 2013). "Marked expansion of exocrine and endocrine pancreas with incretin therapy in humans with increased exocrine pancreas dysplasia and the potential for glucagon-producing neuroendocrine tumors". Diabetes 62 (7): 2595–604. doi:10.2337/db12-1686. PMC 3712065. PMID 23524641.
- "Pancreatic Safety of Incretin-Based Drugs — FDA and EMA Assessment — NEJM".
- Monami M, Dicembrini I, Mannucci E (January 2014). "Dipeptidyl peptidase-4 inhibitors and pancreatitis risk: a meta-analysis of randomized clinical trials". Diabetes Obes Metab 16 (1): 48–56. doi:10.1111/dom.12176. PMID 23837679.