Diabetes: Incretin-Based Drugs Not Linked To Congestive Heart Failure

Kristian Filion, PhD FAHA Assistant Professor of Medicine Division of Clinical Epidemiology Jewish General Hospital/McGill University Montreal, Quebec H3T 1E2 CanadaMedicalResearch.com Interview with:
Kristian Filion, PhD FAHA
Assistant Professor of Medicine
Division of Clinical Epidemiology
Jewish General Hospital/McGill University
Montreal, Quebec H3T 1E2 Canada

Medical Research: What are the main findings of the study?

Dr. Filion: Previous studies have raised concerns that the use of incretin-based drugs, a type of medication used to treat diabetes, may increase the risk of congestive heart failure.  We therefore examined this potential drug safety issue using a large, population-based database, which allowed us to study the safety of these medications in a real world setting.  In doing so, we found that the use of incretin-based drugs was not associated with an increased risk of congestive heart failure among patients with type 2 diabetes.  Similar results were obtained among both classes of incretin-based drugs (glucagon like peptide-1 [GLP-1] analogs and dipeptidyl peptidase-4 [DPP-4] inhibitors), and no duration-response relationship was observed.

Medical Research: Were any of the findings unexpected?

Dr. Filion: In a previous clinical trial called SAVOR-TIMI 53, patients who were randomized to the incretin-based drug saxagliptin had an increased risk of congestive heart failure.  For this reason, our hypothesis was that these drugs were associated with an increased risk.  However, no increased risk was identified, making our results somewhat unexpected.  The discrepancy is likely due to the difference in study setting, with clinical trials involving highly controlled settings with highly selected patient populations and our study conducted using data from everyday clinical practice.

Medical Research: What should clinicians and patients take away from your report?

Dr. Filion: When deciding to prescribe or take a medication, it is important to weigh the potential benefits versus the potential harms for each individual patient.  In this study, we found that incretin-based drugs appear to be safe with respect to heart failure.  However, the potential risk for other adverse events was not assessed in our study and should be considered when deciding the most appropriate treatment choice.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Filion: While this study examined the risk of heart failure associated with incretin-based drugs as a class, future studies are needed to conclusively examine this association among the individual incretin-based drugs.    Furthermore, these anti-diabetic drugs only entered the market recently, and there remains a need for long-term post-marketing surveillance.

Citation:

Incretin-Based Drugs and the Risk of Congestive Heart Failure
Yu OH1, Filion KB2, Azoulay L3, Patenaude V4, Majdan A5, Suissa S6.
Diabetes Care. 2014 Sep 9. pii: DC_141459. [Epub ahead of print]