An overview of alogliptin + pioglitazone for the treatment of type 2 diabetes

ABSTRACT

Introduction

Type 2 diabetes (T2D) is a progressive condition, and sequential additions of therapy are usually required to maintain glycemic control. The options for glucose lowering therapies have increased considerably in recent years. Fixed-dose combinations such as alogliptin with pioglitazone provide a convenient choice which can improve medication adherence.

Areas covered

The authors performed a literature search to identify publications describing the efficacy and safety of alogliptin and pioglitazone when used separately and in combinations.

Expert opinion

Pioglitazone activates peroxisome proliferator-activated receptor-gamma which improves insulin sensitivity and helps to preserve β-cell function with a durable improvement in glycemic control. Pioglitazone can retard the progression of atherosclerosis and reduce cardiovascular events, but it is associated with adverse events including weight gain, fluid retention, and increased risk of fractures. Alogliptin improves glycemic control and appears neutral in terms of cardiovascular events. It does not appear to increase the adverse events associated with pioglitazone and use of the combination may permit the use of lower doses of pioglitazone with reduced adverse effects. There are no cardiovascular outcome studies with the combination but the cardiovascular benefits of pioglitazone and additional glucose lowering effects of alogliptin provide a useful combination with convenient once daily dosing.

KEYWORDS:

• Alogliptin
• cardiovascular events
• fixed-dose combination
• pioglitazone
• type 2 diabetes

Article Highlights

• Alogliptin and pioglitazone have complementary mechanisms of action and the combination provides additional reductions in HbA1c.

• The combination helps to preserve β-cell function and provide durable improvement in glycemic control.

• The combination is safe and well tolerated with no significant increase in the risk for hypoglycemia compared to the individual components.

• Pioglitazone can reduce cardiovascular events and alogliptin appears to be neutral in terms of cardiovascular risk.

• The dose-dependent fluid retention with pioglitazone could be abrogated by using lower doses in combination with alogliptin to increase the glycemic efficacy.

Declaration of Interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Box 1. Drug summary

Additional information

Funding

This work was funded by faculty research funding from the Faculty of Medicine, Macau University of Science and Technology.