All-cause mortality and cardiovascular effects associated with the DPP-IV inhibitor sitagliptin compared with metformin, a retrospective cohort study on the Danish population

TY - JOUR

T1 - All-cause mortality and cardiovascular effects associated with the DPP-IV inhibitor sitagliptin compared with metformin, a retrospective cohort study on the Danish population

AU - Scheller, N M

AU - Mogensen, U M

AU - Andersson, Charlotte

AU - Vaag, A

AU - Torp-Pedersen, C

N1 - © 2013 John Wiley & Sons Ltd.

PY - 2014/3

Y1 - 2014/3

N2 - Aim: We performed a retrospective cohort study, investigating the clinical outcomes including mortality and cardiovascular disease of sitagliptin compared with metformin monotherapies. Methods: All patients receiving monotherapy with the dipeptidyl peptidase-IV inhibitors (DPP-IV) inhibitor sitagliptin between 1 January 2007 and 31 December 2011 were identified. All-cause mortality and a composite endpoint of stroke, acute myocardial infarction (AMI) and all-cause mortality associated with sitagliptin monotherapy were compared with metformin monotherapy. In addition, as an indicator of efficacy we analysed the hazard ratio of changing treatment. Results: A total of 84756 patients were included in the analysis, 1228 (1.4%) received sitagliptin monotherapy whereas the remaining 83528 (98.6%) patients received metformin monotherapy. Patients using metformin were younger than patients using sitagliptin (59.0±15.2 vs. 62.5±13.1) were less often male (51.6 vs. 54.2%) and had longer treatment duration with monotherapy (1.8±1.3 vs. 0.9±1.1years). Compared with patients receiving metformin, patients using sitagliptin showed no statistically significant excess risks of all-cause mortality [hazard ratio, 1.25; 95% confidence interval (CI), 0.92-1.71; p=0.153] or the composite endpoint (hazard ratio, 1.22; 95% CI, 0.92-1.61; p=0.164). However, the use of sitagliptin monotherapy was associated with an increased likelihood of changing treatment (hazard ratio, 4.88; 95% CI, 4.46-5.35; p<0.001). Conclusion: In a retrospective analysis, sitagliptin monotherapy compared with metformin monotherapy was not associated with any statistical significant increased risk of all-cause mortality or the composite endpoint, but was associated with an increased likelihood of changing glucose-lowering treatment.

AB - Aim: We performed a retrospective cohort study, investigating the clinical outcomes including mortality and cardiovascular disease of sitagliptin compared with metformin monotherapies. Methods: All patients receiving monotherapy with the dipeptidyl peptidase-IV inhibitors (DPP-IV) inhibitor sitagliptin between 1 January 2007 and 31 December 2011 were identified. All-cause mortality and a composite endpoint of stroke, acute myocardial infarction (AMI) and all-cause mortality associated with sitagliptin monotherapy were compared with metformin monotherapy. In addition, as an indicator of efficacy we analysed the hazard ratio of changing treatment. Results: A total of 84756 patients were included in the analysis, 1228 (1.4%) received sitagliptin monotherapy whereas the remaining 83528 (98.6%) patients received metformin monotherapy. Patients using metformin were younger than patients using sitagliptin (59.0±15.2 vs. 62.5±13.1) were less often male (51.6 vs. 54.2%) and had longer treatment duration with monotherapy (1.8±1.3 vs. 0.9±1.1years). Compared with patients receiving metformin, patients using sitagliptin showed no statistically significant excess risks of all-cause mortality [hazard ratio, 1.25; 95% confidence interval (CI), 0.92-1.71; p=0.153] or the composite endpoint (hazard ratio, 1.22; 95% CI, 0.92-1.61; p=0.164). However, the use of sitagliptin monotherapy was associated with an increased likelihood of changing treatment (hazard ratio, 4.88; 95% CI, 4.46-5.35; p<0.001). Conclusion: In a retrospective analysis, sitagliptin monotherapy compared with metformin monotherapy was not associated with any statistical significant increased risk of all-cause mortality or the composite endpoint, but was associated with an increased likelihood of changing glucose-lowering treatment.

KW - Denmark

KW - Diabetes Mellitus, Type 2

KW - Diabetic Angiopathies

KW - Dipeptidyl-Peptidase IV Inhibitors

KW - Female

KW - Humans

KW - Hypoglycemic Agents

KW - Male

KW - Metformin

KW - Middle Aged

KW - Myocardial Infarction

KW - Proportional Hazards Models

KW - Pyrazines

KW - Retrospective Studies

KW - Stroke

KW - Treatment Outcome

KW - Triazoles

U2 - 10.1111/dom.12197

DO - 10.1111/dom.12197

M3 - Journal article

C2 - 24020750

SN - 1462-8902

VL - 16

SP - 231

EP - 236

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

IS - 3

ER -