Clinical overview of saxagliptin for Type 2 diabetes management

Saxagliptin (Onglyza™, Bristol-Myers Squibb, NJ, USA and AstraZeneca, DE, USA) is a potent, orally active, once-daily dipeptidyl peptidase-4 inhibitor that is indicated as an adjunct to diet and exercise alone, or in combination with metformin, a thiazolidinedione or a sulfonylurea to improve glycemic control in adults with Type 2 diabetes mellitus. By inhibiting dipeptidyl peptidase-4, saxagliptin increases concentrations of the intact forms of the incretin hormones, glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, prolonging their effects. Saxagliptin also improves β-cell function, increases postprandial insulin secretion and reduces postprandial glucagon secretion. Saxagliptin is generally well tolerated with weight-neutral effects and a low incidence of hypoglycemia. Multicenter randomized trials have shown that saxagliptin as monotherapy, as initial therapy with metformin or as add-on therapy with metformin, a sulfonylurea or a thiazolidinedione leads to significant decreases in glycated hemoglobin levels, fasting and postprandial plasma glucose levels and higher percentages of patients attaining target glycated hemoglobin of less than 7% compared with controls.