Systematic review and meta-analysis of vildagliptin for treatment of type 2 diabetes
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META-ANALYSIS
Systematic review and meta-analysis of vildagliptin for treatment of type 2 diabetes Eleni Bekiari1,2 • Chrysoula Rizava1 • Eleni Athanasiadou1 • Konstantinos Papatheodorou2,3 Aris Liakos1 • Thomas Karagiannis1 • Maria Mainou1 • Maria Rika2 • Panagiota Boura4 • Apostolos Tsapas1,2,5
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Received: 19 September 2015 / Accepted: 19 December 2015 Ó Springer Science+Business Media New York 2015
Abstract This systematic review and meta-analysis provides an update on the efficacy and safety of vildagliptin for treatment of type 2 diabetes mellitus (T2DM). We searched MEDLINE, COCHRANE, EMBASE and the drug manufacturer’s website for randomised controlled trials of vildagliptin in patients with T2DM. Sixty-nine studies (28,006 patients) were included in the meta-analysis. Compared with placebo vildagliptin reduced HbA1c (weighted mean difference WMD -0.69 %; 95 % CI -0.83 to -0.56 %; I2 = 82 %), and it was as effective as other antidiabetic agents (WMD -0.01 %; 95 % CI -0.16 to 0.14 %; I2 = 93 %), without increasing the risk for hypoglycemia (OR 0.83; 95 % CI 0.59 to 1.16; I2 = 0 % vs. placebo, and OR 0.19; 95 % CI 0.15 to 0.24; I2 = 78 % versus active comparators). However, it was associated with an increase in the incidence of arthralgia compared
with other comparators (OR 1.23; 95 % CI 1.02 to 1.48; I2 = 0 %). On the contrary, vildagliptin did not increase the incidence of pancreatitis (OR 0.97; 95 % CI 0.37 to 2.53; I2 = 0 %), serious adverse events (OR 0.98; 95 % CI 0.88 to 1.09; I2 = 0 %) or death (OR 1.10, 95 % CI 0.75 to 1.61; I2 = 0 %). Finally, odds ratio (OR) for heart failure, and overall cardiovascular and cerebrovascular events was 0.77 (95 % CI 0.46 to 1.30; I2 = 0 %) and 0.91 (95 % CI 0.73 to 1.14; I2 = 0 %), respectively. Vildagliptin is an effective and safe therapeutic option for patients with T2DM, both as monotherapy and as add-on treatment. Keywords Vildagliptin DPP-4 inhibitors Systematic review Meta-analysis
Introduction Electronic supplementary material The online version of this article (doi:10.1007/s12020-015-0841-1) contains supplementary material, which is available to authorized users. & Apostolos Tsapas [email protected] 1
Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Hippokratio General Hospital, 49 Konstantinoupoleos Street, 54642 Thessalonı´ki, Greece
2
Diabetes Centre, Second Medical Department, Aristotle University Thessaloniki, Thessalonı´ki, Greece
3
Second Medical Department, Democritus University Thrace, Alexandroupoli, Greece
4
Second Medical Department, Aristotle University Thessaloniki, Thessalonı´ki, Greece
5
Harris Manchester College, University of Oxford, Oxford, UK
Type 2 diabetes is a chronic progressive disease accounting for 85 to 95 % of all diabetes in high-income countries and probably for an even higher percentage in developing countries. The global prevalence is estimated to be around 9 % among adults, while the incidence varies greatly by ethnicity. Diabetes is associate
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