Key result
Starting sitagliptin at >50 mg/d versus ≤50 mg/d in older adults with CKD did not significantly alter the 1-year risk of death or heart failure hospitalization (HR 0.88; 95% CI 0.67-1.14).
Why the study?
Some evidence suggests sitagliptin is associated with an increased risk of congestive heart failure, particularly at higher doses, in patients with CKD.
Does sitagliptin >50 mg/d increase the risk of death or hospitalization with congestive heart failure compared to ≤50 mg/d in older adults with CKD?
Cohort (n=9,215)
Does sitagliptin >50 mg/d increase the risk of death or hospitalization with congestive heart failure compared to ≤50 mg/d in older adults with CKD?
Starting sitagliptin at a higher dose (>50 mg/d) in older adults with CKD does not increase the risk of death or heart failure hospitalization compared to a lower dose (≤50 mg/d).
Answers are grounded in this paper and cite their sources.
Supports higher-dose sitagliptin without apparent excess death or HF hospitalization risk in older adults with CKD; leaves open need for randomized trials.
BACKGROUND AND OBJECTIVES: Sitagliptin, a dipeptidyl peptidase-4 inhibitor, is commonly prescribed to patients with type 2 diabetes. As this drug is primarily eliminated by the kidney, a reduced dose is recommended for patients with CKD. Some evidence suggests that sitagliptin is associated with a higher risk of congestive heart failure, particularly at higher doses. We compare the 1-year risk of death or hospitalization with congestive heart failure in patients with CKD newly prescribed sitagliptin at >50 versus ≤50 mg/d. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: (but not receiving dialysis) who were newly prescribed sitagliptin between 2010 and 2017 in Ontario, Canada. We used inverse probability of treatment weighting on the basis of propensity scores to balance baseline characteristics. The primary composite outcome was death or hospitalization with congestive heart failure. Secondary outcomes included hospitalization with pancreatitis or hypoglycemia, all-cause hospitalization, and glycemic control. Weighted hazard ratios were obtained using Cox proportional hazards regression, and 95% confidence intervals were obtained using bootstrap variance estimators. RESULTS: Of 9215 patients, 6518 started sitagliptin at >50 mg/d, and 2697 started sitagliptin at ≤50 mg/d. The 1-year risk of death or hospitalization with congestive heart failure did not differ significantly between groups (79 versus 126 events per 1000 person-years; weighted hazard ratio, 0.88; 95% confidence interval, 0.67 to 1.14); hospitalization with pancreatitis (weighted hazard ratio, 0.98; 95% confidence interval, 0.32 to 3.03) and hypoglycemia (weighted hazard ratio, 1.10; 95% confidence interval, 0.64 to 1.90) also did not differ significantly between groups. Patients starting sitagliptin at >50 mg/d had lower mean glycated hemoglobin concentrations (weighted between-group difference, -0.12%; 95% confidence interval, -0.19 to -0.06) and a lower risk of all-cause hospitalization (weighted hazard ratio, 0.81; 95% confidence interval, 0.66 to 0.98). CONCLUSIONS: The risk of death or congestive heart failure was not higher in older adults with CKD starting sitagliptin at >50 versus ≤50 mg/d. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_11_25_CJN08310520_final.mp3.
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Muanda et al. (2020) conducted a cohort in Chronic Kidney Disease and Type 2 Diabetes (n=9,215). Sitagliptin vs. ≤50 mg/d was evaluated on death or hospitalization with congestive heart failure (HR 0.88, 95% CI 0.67 to 1.14). Starting sitagliptin at >50 mg/d versus ≤50 mg/d in older adults with CKD did not significantly alter the 1-year risk of death or heart failure hospitalization (HR 0.88; 95% CI 0.67-1.14).
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