[Alogliptin (Vipidia): a selective DPP-4 inhibitor with a good cardiovascular safety]

Alogliptin (Vipidia) is a new selective inhibitor of dipeptidyl peptidase-4. By potentiating insulin secretion and by inhibiting glucagon secretion, both in a glucose-dependent manner, it improves glucose control of type 2 diabetic patients, without increasing the risk of hypoglycaemia and inducing weight gain, with an excellent clinical and biological tolerance. Both efficacy and safety have been demonstrated in randomised controlled trials, in monotherapy or in combination with other oral antidiabetic agents or even insulin. These results were obtained independently of clinical or demographic patient characteristics, including in elderly subjects and in patients with renal insufficiency. However, because alogliptin is eliminated through the kidneys, the usual dose of 25 mg once daily should be reduced to 12.5 mg per day in case of moderate renal impairment and to 6.25 mg per day in case of severe renal failure. Cardiovascular safety of alogliptin has been demonstrated in a large prospective study (EXAMINE) showing non-inferiority versus placebo in type 2 diabetic patients following an acute coronary syndrome.