Saxagliptin: New Therapy for Type 2 Diabetes

Jill K Logan and Alisa K Escaño

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Objective: To evaluate the efficacy of saxagliptin for the treatment of hyperglycemia associated with type 2 diabetes.

Data Sources: A MEDLINE/PubMed search was conducted of all available date ranges from 1990 through October 2009 for literature in the English language, using the search terms saxagliptin, type 2 diabetes mellitus, incretin hormones, and dipeptidyl peptidase-4 inhibitors. The manufacturer of saxagliptin (Onglyza) was contacted for clinical trial information.

Study Selection: Five prospective, randomized controlled trials were reviewed. Studies were included in this review if they had examined saxagliptin and its effects on hyperglycemia. Trials examined included those on saxagliptin monotherapy and those on saxagliptin in combination with metformin, with a sulfonylurea, and with a thiazolidinedione. Data from the MEDLINE/PubMed search, as well as clinical trial data obtained from the manufacturer, were used in this review.

Data Synthesis: Saxagliptin demonstrated statistically significant decreases of 0.43–0.54% in hemoglobin A_1c (A1C) in the monotherapy treatment group. The A1C-lowering effects were the greatest, with a decrease of 2.5% in patients concomitantly administered metformin and saxagliptin as initial therapy. In addition to its effects on A1C, saxagliptin proved to be weight neutral and had minimal risks of hypoglycemia, with hypoglycemia seen only in the saxagliptin in combination with a sulfonylurea group.

CONCLUSIONS: Saxagliptin is an effective treatment for hyperglycemia associated with type 2 diabetes. It is currently a third-line option in the American Diabetes Association treatment algorithm for type 2 diabetes and, based on the trials reviewed here, this is an acceptable place in therapy. Saxagliptin is a good option for patients with diabetes who are at high risk of hypoglycemia.

J Pharm Technol 2010;26:123-8