[Cardiovascular safety of DPP-4 inhibitors compared to that of sulfonylureas]

André J Scheen
Revue Médicale Suisse 2018 August 22, 14 (615): 1468-1472
After metformin monotherapy, the choice between a sulfonylurea and a dipeptidyl peptidase-4 (DPP-4) inhibitor may be critical in clinical practice. This article compares the cardiovascular safety of these two pharmacological classes based on meta-analyses of randomized controlled trials and observational studies. Both approaches show a better cardiovascular safety with DPP-4 inhibitors than with sulfonylureas. However, some heterogeneity exists, most probably explained by differences between the molecules, especially among sulfonylureas as those of last generation (more particularly gliclazide) seem to have a better safety profile. The ongoing head-to-head prospective trial CAROLINA compares the cardiovascular safety of glimepiride and linagliptin in high-risk patients, with results expected in 2019.

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