DR. BERCOVICH: SITAGLIPINA

SITAGLIPINA

Es un inhibidor de la DPP-4 ( dipeptidil peptidasa-4), que potencia la actividad de las incretinas
( GLP-1 y GIP), logrando un mejoramiento del control metabolico en pacientes con diabetes tipo 2.

Puede usarse sola o en combinación con otras drogas, siempre que la celula beta conserve un resto funcional moderado ( metformina, sulfonilureas, tiazolidonas e insulina), se elimina inalterada por orina, por lo que hay que tener precaución en pacientes con insuficiencia renal y clearences menores al 40%.
La dosis recomendada es 50 mg, dos veces al dia 15 minutos antes de las principales comidas o 100mg en una sola toma diaria antes del almuerzo.
Contraindicaciones: Diabetes tipi 1, antecedentes de pancreatitis, IRC avanzada, embarazo, menores de 18 años, ancianos.

Estudio TECOS
Trial Evaluating Cardiovascular Outcomes With  Sitagliptin

Es el estudio de seguridad cardiovascular de mayor duración y envergadura (38 paises) con un inhibidor de la DPP-4, las principales conclusiones: 1) No hubo incremento del riesgo cardiovascular.
                                                                                    2) No hubo incremento de hospitalizaciones por
                                                                                         insuficiencia cardíaca.

ORIGINAL ARTICLE

Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes

Jennifer B. Green, M.D., M. Angelyn Bethel, M.D., Paul W. Armstrong, M.D., John B. Buse, M.D., Ph.D., Samuel S. Engel, M.D., Jyotsna Garg, M.S., Robert Josse, M.B., B.S., Keith D. Kaufman, M.D., Joerg Koglin, M.D., Scott Korn, M.D., John M. Lachin, Sc.D., Darren K. McGuire, M.D., M.H.Sc., Michael J. Pencina, Ph.D., Eberhard Standl, M.D., Ph.D., Peter P. Stein, M.D., Shailaja Suryawanshi, Ph.D., Frans Van de Werf, M.D., Ph.D., Eric D. Peterson, M.D., M.P.H., and Rury R. Holman, M.B., Ch.B., for the TECOS Study Group*

N Engl J Med 2015; 373:232-242

ABSTRACT

Good glycemic control among patients with type 2 diabetes reduces the risk of diabetes-related microvascular complications.1-3 Many antihyperglycemic agents are licensed for the treatment of type 2 diabetes, but questions regarding the long-term cardiovascular safety of some of these agents have been raised.4,5 International regulatory agencies have responded by requiring that new antihyperglycemic agents not only show glucose-lowering ability but also are not associated with clinically meaningful increases in rates of major adverse cardiovascular events.6,7

Sitagliptin, an orally administered dipeptidyl peptidase 4 (DPP-4) inhibitor, prolongs the action of incretin hormones, including glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide, by inhibiting their breakdown. This improves glycemic control in patients with type 2 diabetes, primarily by suppressing glucagon levels and increasing endogenous insulin secretion.8Two previous cardiovascular outcome trials of other DPP-4 inhibitors did not show an increase or decrease in the number of major adverse cardiovascular events but did raise safety concerns regarding a possible elevated risk of hospitalization for heart failure,9,10 with meta-analyses of randomized, controlled trials suggesting an increase of 24 to 25% in such a risk associated with these agents.11,12

In the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), we assessed the long-term cardiovascular safety of adding sitagliptin to usual care, as compared with usual care alone, in patients with type 2 diabetes and established cardiovascular disease.