Endocrine Abstracts

Three eagerly awaited large, randomised, controlled cardiovascular safety trials with new antidiabetic drugs have recently been completed. The results of these studies are of wide interest to the diabetes and cardiology clinical scientific communities, and the results have been presented at diabetes and cardiology scientific meetings. These have studied drugs in each of the new classes of antidiabetic drugs: sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor; lixisenatide, a glucagon-like peptide-1 (GLP-1) receptor agonist; and empagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor.

The impressive reduction in total mortality that was seen with empagliflozin in the EMPA-REG OUTCOME trial will lead to a change in the management of this challenging group of patients, who have existing cardiovascular disease and may be uncontrolled on insulin therapy, and initially the increased use of empagliflozin should be focused on this group. As there are currently no data to support a similar benefit with dapagliflozin or canagliflozin it is likely that empagliflozin will quickly become the most prescribed drug in this class.

Three studies have now demonstrated no cardiovascular benefits with DPP-4 inhibitors and GLP-1 receptor agonist, and although these drugs are well tolerated. From a patient perspective empagliflozin was also well tolerated and reduced weight. The prescribing of DPP-4 inhibitors may well decline in favour of empagliflozin. Writers of guidelines will need to consider revision of guidelines based on the results of these studies, and in time empagliflozin could become the favoured secondline therapy after metformin.