Assessing the Safety of Sitagliptin in Older Participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS)

被引:51
作者
Bethel, M. Angelyn [1 ]
Engel, Samuel S. [2 ]
Green, Jennifer B. [3 ]
Huang, Zhen [3 ]
Josse, Robert G. [4 ]
Kaufman, Keith D. [2 ]
Standl, Eberhard [5 ]
Suryawanshi, Shailaja [2 ]
Van de Werf, Frans [6 ]
McGuire, Darren K. [7 ]
Peterson, Eric D. [3 ]
Holman, Rury R. [1 ]
机构
[1] Univ Oxford, Oxford Ctr Diabet Endocrinol & Metab, Diabetes Trials Unit, Oxford, England
[2] Merck & Co Inc, Merck Res Labs, Kenilworth, NJ USA
[3] Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA
[4] Univ Toronto, St Michaels Hosp, Toronto, ON, Canada
[5] Munich Diabet Res Grp eV, Helmholtz Ctr, Neuherberg, Germany
[6] Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium
[7] Univ Texas Southwestern Med Ctr Dallas, Dept Med, Div Cardiol, Dallas, TX USA
关键词
US ADULTS; MORTALITY; DISEASE; RATES;
D O I
10.2337/dc16-1135
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE Limited data exist regarding safety and efficacy of antihyperglycemic drugs in older patients with type 2 diabetes. The Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) was a randomized, double-blind, placebo-controlled trial assessing the impact of sitagliptin on a primary composite outcome of cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, or unstable angina hospitalizations in patients with type 2 diabetes (HbA(1c) >= 6.5% [48 mmol/mol] and <= 8.0% [64 mmol/mol]) and cardiovascular disease. We analyzed baseline characteristics and clinical outcomes for TECOS participants aged >= 75 years. RESEARCH DESIGN AND METHODS Clinical and safety event summaries are presented for older versus younger participants and for the treatment groups within the older cohort. RESULTS Of 14,351 participants with age recorded, 2,004 (14%) were >= 75 years old (mean age 78.3 years [SD 3.1]), with 68% men and type 2 diabetes duration median 12.0 years (IQR 7, 21). During 2.9 yearsmedian follow-up, older participants had higher rates of the primary outcome (6.46 vs. 3.67 events per 100 person-years; hazard ratio 1.72 [95% CI 1.52-1.94]), death (2.52 [2.20-2.89]), severe hypoglycemia (1.53 [1.15-2.03]), and fractures (1.84 [1.44-2.35]). In the older cohort, sitagliptin did not significantly impact the primary composite (1.10 [0.89-1.36]), death (1.05 [0.83-1.32]), heart failure hospitalization (0.99 [0.65-1.49]), severe hypoglycemia (1.03 [0.62-1.71]), rates of acute pancreatitis and pancreatic cancer, or serious adverse events. CONCLUSIONS Among older patients with well-controlled type 2 diabetes and cardiovascular disease, sitagliptin had neutral effects on cardiovascular risk and raised no significant safety concerns.
引用
收藏
页码:494 / 501
页数:8
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