How Does Linagliptin Compare With Other DPP-4 Inhibitors?

Anne L. Peters, MD, CDE


September 12, 2011

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Hi. I am Dr. Anne Peters, and today I am going to talk about DPP4 (dipeptidyl peptidase-4) inhibitors. In particular, I want to bring you up to date by discussing a new DPP4 inhibitor on the market, linagliptin (Tradjenta™).

We have 3 agents in the DPP4 inhibitor class and these medications are similar in many ways. All 3 DPP4 inhibitors are oral agents [that are] taken once a day. They are simple for patients to take, and they have few side effects. DPP4 inhibitors lower A1c levels by about 0.5% to 0.8%, so they are not big blockbusters in terms of A1c reduction, but in certain patients you will see more improvement than in others. Therefore, the use of this class of drugs is individualized. These drugs do not cause hypoglycemia and they do not cause weight gain; they have many good attributes.

The first DPP4 inhibitor on the market was sitagliptin (Januvia®). Sitagliptin is available in 3 dose strengths: 100 mg, 50 mg, and 25 mg. The dose is determined by the estimated glomerular filtration rate (GFR). You reduce the dose as the patient's GFR declines.

The next DPP4 inhibitor is saxagliptin (Onglyza™). The primary difference between this drug and sitagliptin is that saxagliptin comes in 2 dose strengths, which are also adjusted based on the estimated GFR.

Linagliptin is available in one dose strength; one size fits all in terms of renal function. Thus, the real difference among these drugs is not in terms of effectiveness or side effects as far as we can tell. The difference is based on whether you need to reduce the drug dose based on the patient's renal status. For example, if you have a patient on sitagliptin and the patient's GFR is reduced, you need to make sure the patient receives the correct dose.

No head-to-head trials have compared these 3 DPP4 inhibitors. From a clinical perspective, however, I can tell you that I think they all behave similarly.

This is Dr. Anne Peters for Medscape.


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