Higher dose of sitagliptin does not increase risk for congestive heart failure in CKD
Researchers from Canada observed no link between higher doses of sitagliptin and increased risk for congestive heart failure in a cohort of patients older than 66 years who had both type 2 diabetes and chronic kidney disease.
“Sitagliptin, a dipeptidyl peptidase-4 inhibitor, is commonly prescribed to patients with type 2 diabetes,” Flory T. Muanda, MD, PhD, of the Institute for Clinical Evaluative Studies and Western University, and colleagues wrote. “As this drug is primarily eliminated by the kidney, a reduced dose is recommended for patients with CKD. Some evidence suggests that sitagliptin is associated with a higher risk of congestive heart failure, particularly at higher doses.”
To determine whether sitagliptin dosing impacts the risk for congestive heart failure, Muanda and colleagues compared the 1-year risk for mortality or hospitalization with the condition in 9,215 patients who were newly prescribed sitagliptin at greater than 50 mg/d vs. no more than 50 mg/d (all patients had an eGFR of less than 45 mL/min/1.73 m2 and were not receiving dialysis).
Researchers observed no significant differences between groups regarding 1-year risk for mortality or hospitalization with congestive heart failure (79 vs. 126 events per 1,000 person-years), nor did they find a difference in hospitalizations with pancreatitis or hypoglycemia.
Further findings indicated patients who started sitagliptin at the higher dose had lower mean glycated hemoglobin concentrations and a lower risk for all-cause hospitalization.
According to Muanda and colleagues, these results suggest starting patients with CKD on a higher sitagliptin dose than that which is currently recommended is not “associated with significant harm.”
They concluded that while dose reductions may not be necessary in this patient population, the findings “should be confirmed in future population-based studies using health care administrative databases in other jurisdictions.”