Alogliptin and Heart Failure Outcomes in Patients With Type 2 Diabetes

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• FDA warning in 2016 highlighted increased heart failure (HF) risk with saxagliptin and alogliptin, impacting type 2 diabetes treatment.
• Conflicting data and guidelines exist regarding HF risk, particularly for alogliptin.
• A formulary change at Memphis VA Medical Center provided an opportunity to study alogliptin's HF risk in a large patient cohort.

Purpose of the Study:

• To evaluate the risk of heart failure (HF) associated with alogliptin use in patients with type 2 diabetes.
• To assess HF exacerbation rates, new-onset HF, and drug discontinuation due to HF with alogliptin.

Main Methods:

• Retrospective chart review of 455 patients prescribed alogliptin.
• Primary outcome: composite of HF hospital admissions and emergency department visits.
• Secondary outcomes: HF exacerbation rates in established HF patients, new-onset HF, alogliptin discontinuation, and comparison with saxagliptin.

Main Results:

• A total of 28 HF exacerbations were recorded.
• Patients with established HF had a significantly higher exacerbation rate (26.4%) compared to those without (1.2%).
• Eight patients (2%) developed new-onset HF, and 4 (0.9%) discontinued alogliptin due to HF. No significant difference in HF exacerbations was found between alogliptin and saxagliptin users.

Conclusions:

• Alogliptin use may be associated with an increased risk of HF exacerbation in type 2 diabetes patients who have pre-existing heart failure.
• The findings suggest careful consideration of alogliptin in patients with established HF.
• Further research may be warranted to clarify the HF risk profile of alogliptin.