Vipidia (alogliptin) is the fifth authorised drug in the group of dipeptidyl-peptidase-4 (DPP-4) inhibitors for the treatment of type 2 diabetes as add-on therapy to other glucose lowering drugs. The recommended dose is one tablet of 25 mg once daily.
Head-to-head studies of the various DPP-4 inhibitors have not been conducted, and it is unknown whether the drug group can prevent clinically relevant endpoints such as micro and macro vascular complications and death.
DPP-4 inhibitors are comparable to sulphonylurea (SU) and pioglitazone at reducing HbA1c in patients with type 2 diabetes who cannot achieve the desired treatment target with metformin alone. Moreover, no differences have been demonstrated in the overall occurrence of serious adverse events or death. SU is associated with an increased risk of severe hypoglycaemia.
It is IRF's overall assessment that:
- In a choice between DPP-4 inhibitors and SU as add-on therapy to metformin, the significantly higher treatment price and lack of long-term data for DPP-4 inhibitors on relevant clinical endpoints and safety should be considered when used over a longer period.
- If the new individualised treatment targets for HbA1c are followed, the frequency of severe hypoglycaemia with the currently recommended SU (gliclazide, glimepiride, glipizide) is expected to be low.
- DPP-4 inhibitors can be used as add-on to metformin in patients who despite careful dose titration experience hypoglycaemia during treatment with SU.
- Add-on therapy to metformin should be discontinued if an additional decrease in HbA1c of at least 0.5% (5 mmol/mol) is not achieved within 6 months.
Vipidia was marketed on 25 November 2013, and Vipidia is the cheapest DPP-4 inhibitor at present. General reimbursement is currently granted.