Linagliptin Noninferior to Glimepiride in Type 2 Diabetes

Significantly fewer patients have hypoglycemia, cardiovascular events with use of linagliptin

THURSDAY, June 28 (HealthDay News) -- The dipeptidyl peptidase-4 inhibitor linagliptin is noninferior to the sulphonylurea glimepiride for second-line glycemic control and is associated with significantly less hypoglycemia and fewer cardiovascular events in patients with type 2 diabetes, according to a study published online June 28 in The Lancet.

Baptist Gallwitz, M.D., from the Universitätsklinikum Tübingen in Germany, and colleagues conducted a two-year, parallel-group, noninferiority double-blind trial to compare linagliptin with glimepiride for second-line glycemic control. Outpatients with type 2 diabetes and a hemoglobin A1c (HbA1c) of 6.5 to 10.0 percent on stable metformin alone or with one additional antidiabetic drug that was washed out during screening were randomly allocated to linagliptin (764 patients) or glimepiride (755 patients).

The researchers found that the reductions in HbA1c were similar for the linagliptin and glimepiride groups (−0.16 and −0.36 percent, respectively; difference, 0.20 percent; met the predefined non-inferiority criterion of 0.35 percent). Compared with glimepiride, fewer patients receiving linagliptin had hypoglycemia (7 versus 36 percent) or severe hypoglycemia (<1 versus 2 percent). There were significantly fewer cardiovascular events with linagliptin than with glimepiride (12 versus 26 patients; relative risk, 0.46).

"The present study supports that linagliptin provides noninferior glucose-lowering efficacy with a reduced risk of hypoglycemia and weight gain as compared with glimepiride," the authors write. "Our findings support the use of linagliptin in combination with metformin as a therapeutic option for treatment of type 2 diabetes."

Several authors disclosed financial ties to pharmaceutical companies, including Boehringer Ingelheim, which funded the study and manufactures linagliptin.

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