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DPP-4-remmers en hartfalen
Datum: 21.03.2016
Deze analyse van hartfalen bij gebruik van DPP-4-remmers laat een verschil zien in risico tussen de verschillende middelen.

Bron: Int J Cardiol. 2016 Mar 2;211:88-95. doi: 10.1016/j.ijcard.2016.02.146. [Epub
ahead of print]

Effect of dipeptidyl peptidase-4 inhibitors on heart failure: A meta-analysis of
randomized clinical trials.

Kongwatcharapong J(1), Dilokthornsakul P(2), Nathisuwan S(1), Phrommintikul A(3),
Chaiyakunapruk N(4).


BACKGROUND: Recent studies have suggested that dipeptidyl peptidase-4 inhibitors
(DPP-4 inhibitors) may be associated with increased risk of heart failure (HF),
but evidence was inconclusive. We aimed to determine the effects of DPP-4
inhibitors on risk of HF.
METHODS: An extensive search in PubMed, EMBASE, CINAHL, IPA, Cochrane, and the manufacturers' websites for randomized controlled
trials (RCT) of all DPP-4 inhibitors was performed up to June 2015. All RCTs
comparing DPP-4 inhibitors to any comparators with minimum follow-up of 12weeks
were included. The primary outcome was the occurrence of HF.
RESULTS: A total of 54 studies with 74,737 participants were included for
analysis. Overall, DPP-4 inhibitors were not associated with an increased risk of
HF compared to comparators (relative risk (RR) 1.106; 95% CI 0.995-1.228;
p=0.062). When analyzed individually, saxagliptin was significantly associated
with the increased risk of HF (RR 1.215; 95% CI, 1.028-1.437; p=0.022), while
others were not. Age≥65years, diabetes duration of ≥10years and BMI≥30kg/m(2)
were associated with an increased risk of HF among patients using saxagliptin.
CONCLUSIONS: Our meta-analysis suggested a differential effect of each DPP-4
inhibitor on the risk of HF. Use of saxagliptin significantly increases the risk
of HF by 21% especially among patients with high CV risk while no signals were
detected with other agents. This information should be taken into consideration
when prescribing DDP-4 inhibitors.

PMID: 26991555