MD Conference Express - ENDO 2015 - (Page 6)

FEATUrED ArTIClES Table 2. Ongoing Cardiovascular Trials for Diabetes Drugs (Noninsulin) Study Class SAVOR EXAMINE TECOS CAROLINA CARMELINA DPP4i Saxagliptin Alogliptin Sitagliptin Linagliptin Linagliptin Placebo Placebo Placebo Sulfonylurea Placebo Comparator No. Results 16 500 5400 14 000 6000 8300 2013 2013 2015 2017 2017 LEADER Comparator No. Results SGLT2i Comparator SUSTAIN6 EXSCEL REWIND Liraglutide Lixisenatide Semaglutide Exenatide LR Dulaglutide Placebo Placebo Placebo Placebo Placebo 16 500 14 000 6000 5400 8300 2016 2015 2016 2018 2019 EMPA-REG GLP1-RA ELIXA CANVAS DECLARE NCT01986881 Empaglifozin Canagliflozin Dapagliflozin Ertugliflozin Placebo Placebo Placebo Placebo No. 7300 4300 22 200 3900 Results 2015 2017 2019 2020 DPP4i, dipeptidyl peptidase-4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, sodium-glucose cotransporter-2 inhibitor. Reproduced with permission from SE Inzucchi, MD. A number of other trials are ongoing, with results due over the next few years (Table 2). Dr Inzucchi emphasized that although these preliminary studies may report effects on CV markers and surrogates, these effects do not necessarily predict what will happen to patients in terms of actual clinical events in the CVOTs. In addition, while the drugs may present no CV safety signals during these trials, it may be overly optimistic to think that they will show any differences in effectiveness on CV end points over a period of just 2 to 4 years. And because the FDA has demanded the recruitment of high-risk patients into these CVOTs, there is some concern that the presence of advanced CV disease and an underlying predilection for further overt macrovascular complications will outweigh any possible CV benefits of a glucose-lowering drug. Dr Inzucchi then reviewed the updated 2015 American Diabetes Association/European Association 6 May 2015 for the Study of Diabetes treatment algorithm for managing hypertension in T2DM (Figure 1). He noted that if any of the compounds included in 1 of the ongoing CVOTs were to show a CV benefit, the current treatment algorithm would likely be updated to reflect that benefit. In closing, Dr Inzucchi emphasized that although diabetes confers additional CV disease risk, glycemic control itself appears to only modestly reduce nonfatal MI. Any benefit from glycemic control will likely have to accrue over many years and may be negated by progressive atherosclerosis. The ideal glucose-lowering agent will reduce CV events as well as maintain glycemic control. For now, however, glycemic control should be used mainly to prevent microvascular complications, while control of lipids and BP is the best means for preventing macrovascular complications. www.mdce.sagepub.com http://mdce.sagepub.com

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MD Conference Express - ENDO 2015