Linagliptin versus glimepiride add-on for the long-term treatment of Type 2 diabetes mellitus

Abstract

Evaluation of: Gallwitz B, Rosenstock J, Rauch T et al. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomized, double-blind, non-inferiority trial. Lancet 380(9840), 475–483 (2012).

In a recent long-term Phase III comparative trial by Gallwitz et al., the dipeptidyl peptidase-4 inhibitor linagliptin demonstrated noninferior glycemic efficacy compared with glimepiride as add-on therapy to metformin in patients with Type 2 diabetes. Linagliptin was associated with a 54% reduction in the risk of cardiovascular events, mainly driven by a 73% reduction in nonfatal stroke compared with glimepiride. This hypothesis-generating finding may be partly due to the low risk of hypoglycemia inherent to the mechanism of action of linagliptin as well as the relative weight reduction observed with linagliptin compared with glimepiride. The cardiovascular safety profile of linagliptin in direct comparison with glimepiride is being definitively assessed in the CAROLINA trial, due to complete in September 2018 (ClinicalTrials.gov identifier: NCT01243424).

Keywords::

• dipeptidyl peptidase-4 inhibitor
• glimepiride
• linagliptin
• Type 2 diabetes

Financial & competing interests disclosure

The author has no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

The author was fully responsible for all content and editorial decisions, was involved at all stages of manuscript development and has approved the final version of the review that reflects the authors’ interpretation and conclusions. Medical writing assistance, supported financially by Boehringer Ingelheim, was provided by Sharon Rayner and Michael P. Bennett of Envision Scientific Solutions during the preparation of this review. Boehringer Ingelheim was given the opportunity to check the data used in the manuscript for factual accuracy only.