Beruflich Dokumente
Kultur Dokumente
1
Riwayat Hidup :
Nama : Dr Eddy Supriadi, Sp.PD, FINASIM
Tempat/ Tgl. Lahir : Jakarta, 19 Feb 1968
Pendidikan : Dokter FKUI 1993, Penyakit Dalam
FKUI 2006
Tempat Kerja : RS Dr H. MARZOEKI MAHDI
Pengalaman :
- Inspire Diabetes Program. PERKENI Indonesia-
STENO Denmark. Jakarta 2013.
- Workshop and Symposium on the Diabetic Foot.
Noordwijkerhout, The Netherlands, 2011
- dll.
The Prevalence of Diabetes Mellitus Worldwide
DIABETES UPDATE
4
ADA Diabetes Care 2015
5
Classification and Diagnosis of Diabetes
A1C ≥6.5%
OR
Fasting plasma glucose (FPG)
≥126 mg/dL (7.0 mmol/L)
OR
2-h plasma glucose ≥200 mg/dL
(11.1 mmol/L) during an OGTT
OR
A random plasma glucose ≥200 mg/dL
(11.1 mmol/L)
ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl 1):S9; Table 2.1 6
Categories of Increased Risk for Diabetes
(Prediabetes)*
*For all three tests, risk is continuous, extending below the lower limit of a range and becoming
disproportionately greater at higher ends of the range.
ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl 1):S10; Table 2.3 7
Approach to the Management of
Hyperglycemia
ADA. 6. Glycemic Targets. Diabetes Care 2015;38(suppl 1):S37. Figure 6.1; adapted with
permission from Inzucchi SE, et al. Diabetes Care, 2015;38:140-149 8
Antihyperglycemic Therapy in
Type 2 Diabetes
If not controlled
in
3 months
3 months
3 months
ADA. 7. Approaches to Glycemic Treatment. Diabetes Care 2015;38(suppl 1):S43. Figure 7.1;
adapted with permission from Inzucchi SE, et al. Diabetes Care, 2015;38:140-149 9
PERKENI 2015
10
Perkeni Guideline for T2DM Management (2011)
12
Different Binding Kinetics within DPP-4 Class
Natural K1 K2
substrate:
(GLP-1)
+ K-1 Fast
+
(~1 sec)
GLP-1 DPP-4 GLP-1: DPP-4 Inactive DPP-4
complex GLP-1
Substrate K1 K2
acting as
inhibitor:
+ K-1
Slow
(~ 1 h)
+
Slow dissociation
(vildagliptin,
saxagliptin) Substrate-like DPP-4 Substrate-like Inactive DPP-4
enzyme blocker enzyme blocker: substrate-like
DPP-4 complex enzyme blocker
Competitive K1
inhibitor:
(sitagliptin,
+ K-1
alogliptin) Fast dissociation
Inhibitor DPP-4 Inhibitor: DPP-4
complex
DPP-4=dipeptidyl peptidase-4; GLP-1=glucagon-like peptide-1.
Burkey BF, et al. Poster 0788 presented at EASD 2006; Deacon CF, Holst JJ. Adv Ther. 2009; 26: 488–499;
Miller SA, St Onge EL. Ann Pharmacother. 2006; 40: 1336–1343; Neumiller JJ. J Am Pharm Assoc. 2009; 49: S16–S29;
Potashman MH & Duggan ME. J Med Chem 2009; 52: 1231-1246. White JR. Clin Diabetes. 2008; 26: 53–57.
13
Tight substrate-like binding of vildagliptin leads to
potent DPP-4 inhibition
GLP-1 GLP-1
GLP-1
GLP-1
Competitive Vildagliptin
inhibitor
DPP-4 DPP-4
GLP-1
GLP-1
DPP-4=dipeptidyl peptidase-4; GLP-1=glucagon-like peptide-1. Burkey BF, et al. Poster 0788 presented at EASD 2006; Deacon CF, Holst JJ. Adv Ther.
2009; 26: 488–499; Miller SA, St Onge EL. Ann Pharmacother. 2006; 40: 1336–1343; Neumiller JJ. J Am Pharm Assoc. 2009; 49: S16–S29; Potashman
MH, Duggan ME. J Med Chem 2009; 52: 1231–1246; White JR. Clin Diabetes. 2008; 26: 53–57.
14
Relationship between Drug Exposure and GLP-1 Levels
with Vildagliptin and Sitagliptin
120 Drug exposure1 Vildagliptin 50 mg twice daily
100
Drug Levels
15
Comparison of Plasma Glucagon Levels following
3 Months’ Treatment with Vildagliptin or Sitagliptin
Vildagliptin 50 mg
twice daily + metformin (N=18)
90 Sitagliptin 100 mg once
daily + metformin (N=20)
Plasma Glucagon (mg/dL)
80
70
60
50
40
30
20
-20 0 15 30 60 90 120 180 240 300 0 15 30 60 90 120 180 240 300 0 15 30 60 90 120 180 240 300 min
↑ production of
free radicals
Proportional to PPG HbA1c Reflects the level of
(glycation) FPG and PPG
magnitude of PPG
excursion
↑ formation Activation
and urinary of Acute glucose
excretion
rate of 8-iso- FPG oxidative fluctuations
PGF2α stress (MAGE)
Significantly
higher in
T2DM
(p<0.01) Correlated with
urinary excretion rate
of 8-iso-PGF2α
8-iso-PGF2α is a parameter of activation of oxidative stress
Adapted from Monnier L, Colette C. Diabetes Care 2008;31(Suppl2):S150-4 19
Glucose Tetrad Concept
Glucose fluctuations and activation of oxidative stress contribute to
progression of vascular complications
Baghurst PA. Diabetes Technol Ther 2011;13:296-301 Example of final MAGE calculation
2 main advantages of MAGE
• The parameter is not dependent on the mean
glucose value
• It is designed to quantitate major glucose swings
and exclude minor ones
800
400
0
Vildagliptin Sitagliptin
Baseline Week 8
Conclusion
Addition of DPP-4 inhibitor significantly reduced glycaemic variability with
no difference between the two drugs
However vildagliptin induced better circadian glycaemic control than
sitagliptin with a significant decrease on over all hyperglycaemia
Adapted from Guerci B et al. Diabetes Metab 2012;38:359-66 24
Objective:
Evaluate the effects of two dipeptidyl peptidase-IV (DPP-4) inhibitors,
sitagliptin and vildagliptin, known to have different efficacy on :
Mean amplitude of glycemic excursions (MAGE)
Oxidative stress
Systemic inflammatory markers in patients with type 2 diabetes
Vildagliptin Concept In
T2DM Therapy
29
Vildagliptin and GLP-1 inactivation
30
REAL WORD EFFECTIVENESS DATA
31
27 Countries participating in EDGE
One of the largest T2DM observational studies ever conducted in a real-world setting
12-month observational, multicenter, post-authorisation, prospective cohort study, which included
45,868 patients from 27 countries worldwide
Europe
Austria, Belgium, Czech Republic, Germany, Greece, Netherlands,
Portugal, Slovakia, Sweden, Bulgaria, Luxembourg, Russia
Middle East
Jordan, Palestine, Lebanon,
Bahrain, Kuwait, Oman
United Arab Emirates
Adapted from Mathieu C, et al. Effectiveness and tolerability of second-line therapy with vildagliptin vs. other oral agents in type 2
diabetes: A real-life worldwide observational study (EDGE). Int J Clin Pract. 2013 Oct;67(10):947-56. 3232
The EDGE Study
One of the largest T2DM observational studies ever conducted in a real-world setting
12-month observational, multicenter, post-authorisation, prospective cohort study, which included 45,868
patients from 27 countries worldwide
BL=baseline
OAD comparators used: metformin, SU, TZD, AGI, glinide; other DPP-4 inhibitors and GLP-1 analogues are
excluded
Adapted from Mathieu C, et al, Int J Clin Pract 2013;67:947-56 33
Vildagliptin as add-on metformin in real-life setting:
-1.1% HbA1c reduction
Broadly consistent with the decrease seen in randomized controlled trial settings
0
HbA1c change (%) 0
-0.2
-0.2
-0.4
-0.4
-0.6 Vilda 50 mg qd
Vildagliptin -0.6
Comparator Vilda 50 mg bid
-0.8 -0.7
-0.8
-1
-0.99 -1
-1.2 -1.1
-1.19 -1.2
-1.4
Consistent efficacy
35
GUARD STUDY: data from >19,000 patients with T2DM
pooled from 4 different regions
0 0
n=3,216 n=14,807
Mean change in HbA1c
from baseline (%)†
–2 –2
–1.17*
–1.29*
–4 –4
†At baseline, the mean overall HbA1c was 8.20 ± 0.88% (n=3,345) in the vildagliptin treatment group and 8.44 ± 0.85 (n=15,424) in the
vildagliptin plus metformin group.
BL, baseline; HbA1c, glycated haemoglobin; SD, standard deviation. Full analysis set, patients from vildagliptin and vildagliptin + metformin
treatment groups with a value for baseline HbA1c and at least one post-baseline HbA1c value available, last observation carried forward.
*p<0.0001 vs. baseline (twosided t-test)
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes
Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
38
GUARD: proportion of patients achieving target
HbA1c ≤7.0% at Week 24
100 100
Proportion of patients at
80 80
60 60
47.2
42.8
40 40
20 20
n=3,511 n=15,820
0 0
HbA1c, glycated haemoglobin; Full analysis set, patients from vildagliptin and vildagliptin + metformin treatment groups with a value for
baseline HbA1c and at least one post baseline HbA1c value available, last observation carried forward
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes
Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
39
GUARD: significant reductions from baseline to Week 24 in
mean HbA1c across baseline HbA1c
BL HbA1c
category, %‡ ≤8 >8–9 >9–10 >10 ≤8 >8–9 >9–10 >10
0 0
n=1,427 n=1,298 n=464 n=27 n=4,686 n=7,173 n=2,634 n=314
–1
Mean change in HbA1c
–1
from baseline (%)
–0.84*
–0.81* –2
–2 –1.30*
–1.26*
–3 –1.89* –3 –1.84*
–4 –4
–5 –3.06* –5 –3.30*
Mean change in HbA1c at Week 24 according to baseline HbA1c level. Corresponding mean (SD) HbA1c values at baseline for vildagliptin group
respectively were:7.47, 8.51, 9.45, 11.40 and and vildagliptin added to metformin group were: 7.56, 8.54, 9.45, and 11.02.
BL, baseline; HbA1c, glycated haemoglobin. Full analysis set, patients from vildagliptin and vildagliptin + metformin treatment groups with a value for
baseline HbA1c and at least one post-baseline HbA1c value available, last observation carried forward. *p<0.0001 vs. baseline (twosided t-test).
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes Metab. 2015
Jan 14. doi: 10.1111/dom.12436 In press.
40
GUARD: significant reductions from baseline to Week 24 in mean HbA1c
with vildagliptin monotherapy regardless of obesity status and age
–1 –1
–2 –2
–1.16* –1.27* –1.17*
–1.11*
–3 –3
–4 –4
*P<0.0001 vs baseline (two-sided t-test). †At baseline, mean overall HbA1c was 8.21 ± 0.86% (non-obese; n=2,355) and 8.18 ± 0.94% (obese;
n=646); 8.22 ± 0.87% (aged <65 years; n=3,129) and 7.93 ± 1.01% (aged ≥65 years; n=187)
Full analysis set (consisting of all patients who provided informed consent and entered into the study); analysis conducted in patients with a value for
baseline (BL) HbA1c and at least one post-BL HbA1c value (if Week 24 value was missing, the last post-BL observation was carried forward).
BMI=body mass index
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes
Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
41
GUARD: significant reductions from baseline to Week 24 in mean HbA1c
with vildagliptin + metformin regardless of obesity status and age
–1
Mean change in HbA1c
–1
from baseline (%)†
–2 –2
–1.26* –1.29*
–1.41* –1.35*
–3 –3
–4 –4
*P<0.0001 vs baseline (two-sided t-test). †At baseline, mean overall HbA1c was 8.43 ± 0.84% (non-obese; n=9,316) and 8.49 ± 0.88% (obese;
n=4,398); 8.45 ± 0.85% (aged <65 years; n=14,289) and 8.37 ± 0.96% (aged ≥65 years; n=1,007)
Full analysis set (consisting of all patients who provided informed consent and entered into the study); analysis conducted in patients with a value for
baseline (BL) haemoglobin A1c (HbA1c) and at least one post-BL HbA1c value (if Week 24 value was missing, the last post-BL observation was
carried forward). BMI=body mass index
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes
Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
42
GUARD: changes in body weight and BMI from baseline to
Week 24
0 0
weight from baseline (kg)
Mean change in body
–1 –1
–1.1*
–1.5*
–2 –2
–3 –3
–4 –4
*P<0.0001 vs baseline
• At Week 24, mean body mass index (BMI) decreased from baseline by 0.4 kg/m2 with vildagliptin
and 0.5 kg/m2 with vildagliptin + metformin (both P<0.0001 vs baseline)
Mean body weight and BMI at baseline: 75.7 kg and 27.4 kg/m2 for vildagliptin monotherapy; 78.6 kg and 28.5 kg/m2 for
vildagliptin + metformin.
Adapted from Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study.
Diabetes Obes Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
43
GUARD: AEs and SAEs
Full analysis set (consisting of all patients who provided informed consent and entered into the study); analysis conducted in patients with a value for baseline
(BL) haemoglobin A1c (HbA1c) and at least one post-BL HbA1c value; AE=adverse event; HE=hypoglycaemic events; SAEs=serious adverse events
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes
Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
44
GUARD study: conclusions
This effect was observed irrespective of patient age or obesity status and was
seen across baseline HbA1c categories
Overall, the findings from the real-world GUARD study are generally consistent
with other real-world studies and interventional controlled clinical trials with
vildagliptin with/without metformin
Rosales et al. 2015. Clinical effectiveness and safety of vildagliptin in >19,000 patients with type 2 diabetes: the GUARD study. Diabetes Obes
Metab. 2015 Jan 14. doi: 10.1111/dom.12436 In press.
45
Safety and Efficacy Profile in
T2DM Patiens With Moderate and
Severe Renal Impairment
Analysis of data from 102 prospective studies on diabetes morbidity and
mortality comparing those with and without diabetes in 698 782 pts
48
Considerations for management of T2DM in renal impairment
Renal function
Normal Mild RI Moderate Severe Terminal
GFR (mL/min) >90 60–90 <60 <30 <15
SGLT-2 inhibitor (dapagliflozin)1
Metformin2
Sulphonylurea (glimepiride)3,4
GLP-1 analogue (exenatide)2
Acarbose2
Pioglitazone5
Repaglinide, Nateglinide6,7
Insulin2
DPP-4 inhibitors (e.g. saxagliptin, sitagliptin, vildagliptin, linagliptin)2
SGLT-2=sodium/glucose cotransporter 2
1. SmPC: Forxiga 5 mg & 10 mg film coated tablets (dapagliflozin); 2. Russo et al. Diabetes Metab Syndr Obes 2013;6:161–70; 3. SmPC: glimepiride 2 mg
tablets; 4. Product monograph, Amaryl, September 2013; 5. SmPC: Actos tablets (pioglitazone); 6. SmPC: repaglinide 2 mg tablets and nateglinide 60/120 mg
tablets; 7. Yale. J Am Soc Nephrol 2005;16:S7–10
Is There Evidence of Any Safety Differences Among
DPP-4 inhibitors in Treatment of People with T2DM and
CKD?
-1.0%
-1.1%
Reference
Thuren T, et al, EASD 2008. Poster, 88
Active Comparator: metformin, pioglitazon, rosiglitazon
52
Stages of chronic kidney disease / guideline
Chronic kidney disease is defined as either kidney damage or GFR <60 mL/min/1.73m2 for
≥3 months. Kidney damage is defined as pathologic abnormalities or markers of damage, including
abnormalities in blood or urine tests or imaging studies.
^National Kidney Foundation. KDOQI, Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification.
CKD, chronic kidney disease; GFR, glomerular filtration rate
53
Pharmacokinetic parameters of Vildagliptin
in Various Renal Condition
Controls Moderate Controls to Controls to
Parameter
HS Mild RI to mild RI RI moderate RI Severe RI severe RI
(n=46) (n=16) (n=16) (n=16) (n=16) (n=18) (n=14)
Plasma
Cmax, ng/ml 251 (79) 326 (77) 245 (83) 343 (139) 258 (96) 361 (137) 253 (58)
tmax, h 1.5 (0.5, 3.0) 1.5 (0.5, 2.0) 1.5 (0.5, 3.0) 2.0 (0.5, 3.0) 1.5 (0.5, 3.0) 1.8 (1.0, 3.0) 1.5 (1.0, 2.0)
AUC0–24h, ng*h/ml 990 (237) 1323 (291) 954 (215) 1810 (688) 1038 (264) 2113 (1130) 980 (240)
t½, h 2.8 (2.1) 2.7 (1.2) 2.9 (2.2) 3.1 (1.0) 2.1 (0.6) 3.6 (1.3) 3.3 (2.9)
Data are mean (SD) unless specified otherwise.
Ae0-24h, amount of vildagliptin excreted in the urine during the interval of 0–24 hours, AUC0–24h, area under the plasma concentration time curve
from 0–24 hours, Cmax, maximum plasma concentration; CLR, renal clearance; CL/F, oral clearance; HS, healthy subjects; RI, renal imapirment;
t1/2, terminal elimination half-life; tmax, time to maximum plasma concentration. For tmax median (min, max) is presented.
Vildagliptin AUC increased on average 1.4, 1.7 and 2-fold in patients with mild, moderate and severe RI, respectively, compared with
normal healthy subjects.
54
Conclusions
• The pharmacokinetic results from this study indicate that no dose adjustment for
vildagliptin is necessary in patients with mild RI (50 mg bid).
55
Effecicay of Vildagliptin in MODERATE and
SEVERE Renal Disease
Aim: To assess the effects of vildagliptin 50 mg qd in patients with advanced type 2 diabetes and
moderate or severe RI whose hyperglycemia was not adequately controlled with insulin alone or in
combination with an oral anti-diabetic agent at baseline.
Study design: This was a 24-week, multicenter, randomized, double-blind, parallel group, placebo-
controlled trial of vildagliptin in adult patients (age 18–85 years) with T2DM and moderate or severe RI
(eGFR by the MDRD formula ≥ 30 to <50 and <30 ml/min/1.73 m2, respectively).
Period I Period II
Placebo run-in plus stable
dose of current therapy* Vildagliptin 50 mg qd + current therapy (N=289)
N=525
Placebo + current therapy (N=226)
eGFR, estimated glomerular filtration rate; MDRD, modification of diet in renal disease; RI, renal impairment
56
Patient demographics and background
characteristics were comparable at baseline
57
Concomitant anti-diabetic therapy at baseline
were comparable between treatment groups
58
Vildagliptin sustained HbA1c reduction over 24
weeks in both moderate and severe RI patients
Time-course of mean HbA1c (±SE) during rescue-free treatment in patients with moderate or severe RI
8.1
Moderate
ModerateRI
RIpatients
patients Severe RI patients
8.1
7.9 7.9
7.7 7.7
Mean HbA1c (%)
7.3 7.3
7.1 7.1
6.9 6.9
6.7
0
6.7
0
-4 0 4 8 12 16 20 24
-4 0 4 8 12 16 20 24
Weeks of Treatment Weeks of Treatment
Vildagliptin 50 mg qd
Placebo
59
Overall safety and tolerability of vildagliptin was similar to
placebo in moderate/severe RI patient
*None of the deaths were suspected to be related to study drug. A patient with multiple occurrences of an adverse event under one treatment
is counted only once in the adverse event category for that treatment. RI, renal impairment
60
Incidences of common AEs (≥5%) were similar between
groups in moderate / severe RI patients
61
Incidence of Hypoglycemia in T2DM Patient with
Moderate and severe RI receiving Vildagliptin
The number of patients experiencing HE in moderate RI were 28 (17.2%) for vildagliptin and
15 (11.6%) for placebo. In the severe RI group, the number of patients experiencing HE was
19 (15.3%) for vildagliptin group and 12 (12.4%) for placebo.
RI = Renal Impairment, HE = Hypoglycemic Event
Adapted from Lukasevich V., et al, Diabetes, Obesity and Metabolism 13: 947–954, 2011
62
Vildagliptin is efficacious and well tolerated in
T2DM patients with MODERATE and SEVERE RI
Effectively reduced HbA1c Proven good tolerability
24-week treatment 24-week treatment
Any Adverse Events (AE’s) (%)
Moderate Severe
7.9% 7.8% 7.7% 7.7%
75 72.9 72.6 74.2
Baseline
0 70 67.5 Vildagliptin
65 Placebo
-0.2
-0.2 60
-0.4 -0.3 110 94 90 72 (n)
Moderate Severe
-0.6
Vildagliptin Any Serious Adverse Events (SAE’s) (%)
-0.8 -0.7 30
Placebo
18.5 20.6
-1 -0.9 20 Vildagliptin
9.2 8.5 Placebo
10
p<0.0001 vs. placebo
0
15 11 23 20 (n)
Moderate Severe
Vildagliptin 50 mg qd, placebo qd
Moderate: eGFR ≥ 30 - < 50 ml/min/1.73 m2; severe Renal Impairment: eGFR < 30 ml/min/1.73 m2, RI = Renal Impairment
Adapted from Lukasevich V., et al, Diabetes, Obesity and Metabolism 13: 947–954, 2011
63
Conclusions
• Treatment with vildagliptin (50 mg qd) added to ongoing anti-diabetic therapy was
well-tolerated, with a safety profile comparable to placebo.
• In patients with moderate or severe RI, vildagliptin added to current therapy elicited
robust improvements in glycemic control with HbA1c reductions of ∼0.7% (from
baseline 7.9% in moderate RI) and ∼0.9% (from baseline of 7.7% in severe RI).
64
Long-term Safety and Efficacy in Moderate
and Severe Renal Disease
● Aim: To assess long-term safety and efficacy of vildagliptin 50 mg qd in patients with T2DM and
moderate or severe RI.
● Design: This was a long-term extension of a randomized, double-blind, parallel-group, placebo-
controlled 24-week clinical trial. Adult patients (age 18–85 years) having T2DM and moderate or
severe RI (eGFR by the MDRD formula ≥ 30 to <50 mL/min/1.73 m2 and <30 mL/min/1.73 m2,
respectively) were included in this study.
N=515
Placebo + current therapy Placebo + current therapy
(N=226) (N=153)
65
Vildagliptin maintained HbA1c reduction over 52 weeks in both
moderate and severe RI patients
8.4
8.0
Moderate RI patients Severe RI patients
8.0
Mean HbA1c (%)
7.6
7.2 6.8
6.8 6.4
-2 BL 4 8 12 16 20 24 40 52 EP -2 BL 4 8 12 16 20 24 40 52 EP
Time (week) Time (week)
Vildagliptin 50 mg qd
Placebo
Absolute mean change in HbA1c (%) from baseline to rescue-censored extension endpoint. Extension full analysis set. BL, baseline; EP, end point; RI, renal
impairment; SE, standard error
66
Vildagliptin Has Comparable Safety Profile Compared to Placebo
Over 52 Weeks in T2DM patients with Moderate and Severe RI
Moderate Severe
Any suspected
31 (25.4) 22 (24.7) 24 (25.5) 18 (28.1)
drug-related AE
Any AE leading to
6 (4.9) 5 (5.6) 9 (9.6) 4 (6.3)
discontinuation
The number of moderate RI patients experiencing HE in vildagliptin group is 32 (26.2%) , in placebo group 15 (16.9%) , with 2 patients
(1.6%) in vildagliptin group has severe Hypoglycemia and 3 (3.4%) in placebo group. In the severe RI patient, there are total of 17
(18.1%) patient experiencing HE in vildagliptin group and 11 (17.2%) patients in placebo group.
There was a slightly higher incidence of mild hypoglycaemia in patients with moderate RI treated with
vildagliptin than with placebo.
Rates of hypoglycaemia in patients with severe RI were similar across treatment groups.
Very few events of severe hypoglycaemia, and more with placebo than vildagliptin.
incidence of hypoglycaemia with vildagliptin in the present study (∼26% in patients with moderate RI and
∼18% in those with severe RI) appears to be lower than that expected (≥50%) in patients with
longstanding T2DM and low baseline A1C (∼7.6%).
HE = Hypoglycemic event ; RI = Renal Impairment
Adapted from Kothny et al, Diabetes obes Metab 14: 1032-1039, 2012 68
Vildagliptin maintained HbA1c reduction over 52 weeks in
T2DM patients with moderate and severe RI
This is the largest long-term study with a DPP-4 inhibitor in patients with T2DM and
moderate or severe RI.
Vildagliptin maintained the robust efficacy throughout 52 weeks with HbA1c
reductions of ~0.6% and ~0.8% from baselines of 7.8% and 7.7% in moderate and
severe RI, respectively.
Safety profile of vildagliptin 50 mg qd was similar to placebo when added to anti-
diabetic therapy during 1-year observation.
The incidence of hypoglycemia with vildagliptin (26% in moderate and 19% severe RI
groups) was lower than expected in patients with longstanding T2DM receiving
insulin ± OADs and achieving significantly tighter glycemic control at low baseline
HbA1c (~7.6%). The risk of severe hypoglycemia was very low.
These data support the long-term safety and efficacy of vildagliptin 50 mg qd added
to ongoing anti-diabetic therapy in patients with moderate or severe RI.
OAD, oral anti-diabetes drug; qd, once daily; RI, renal impairment; T2DM, type 2 diabetes mellitus
70
Thank You
71
72
73
74
OPTIMA study: Vildagliptin vs. Sitagliptin
Vildagliptin provide 24-hours better glucose fluctuation control and give
longer blood glucose ideal range significantly than Sitagliptin