Good news/bad news for diabetics taking medications referred to as DPP-4 therapies. While a new study by researchers at Brigham and Women's Hospital in Boston has shown that the drugs, which include Onglyza and Nesina,* (manufactured by AstraZeneca/BristolMeyers and Takeda respectively) do not raise the risk of heart attacks, there is speculation that they might be tied to heart failure, in cases where the heart fails to pump blood adequately.
Although not the most potent medications for lowering glucose levels, the DDP-4 class of drugs work by inhibiting dipeptidyl peptidase-4, and are generally well tolerated by patients with mild cases of type 2 diabetes. The market is currently dominated by Januvia (Merck), as well as the related combination treatment Janumet, with total annual revenue estimated to be close to $5 billion.
"It is a little bit concerning," said Dr. Christopher Grainger of Duke University Medical Center, who was not involved in the research. "I'm sure the FDA will want to know more about it. On the positive side, the drugs were not associated with increased rates of either inflammation of the pancreas or cancer, a matter of concern in the past.”
However, Dr. Heinz Drexel, a heart specialist at Feldkirch Hospital in Austria and a spokesman for the European Society of Cardiology (ESC), said “DPP-4s still offered several advantages, including a lack of weight gain seen with some other anti-diabetics such as Actos, which would offset the heart failure worries.”
Full results of the Onglyza study were presented at the ESC annual congress in Amsterdam, and published at the same time in the New England Journal of Medicine alongside a 5,380-patient study of Nesina. However, while both studies showing “no overall increase in cardiovascular risks,” the researchers owned up to the fact that none of them were able to “identify any diabetes drug that is not only safe but actually beneficial to the heart.”