The Efficacy And Safety Of DPP-â…£ Inhibitors Monotherapy Or In Combination With Metformin: A Meta-analysis

Objective: To assess the efficacy and safety of DPP-IV inhibitorsmonotherapy versus placebo, the combination of DPP-IV inhibitors andmetformin versus metformin (MET) monotherapy or the combination ofsulfonylureas (SU) and metformin in patients with T2DM.Methods: A comprehensive search for randomized controlled trials(RCTs;≥24weeks) was performed. RCTs had to compare DPP-IVinhibitors therapy with placebo, metformin and sulphonylureas+metformin. Mean difference (MD) with95%CI was calculated for the meanHbA1c changes (%) from baseline to (imputed) endpoint. Odds ratio (OR)with95%CI was calculated for side reactions. The meta-analysis wasperformed using Rev-Man5.1.Results:23RCTs were included. The mean HbA1c changes [%], MD,95%CI=0.11[0.04,0.18], p=0.002(DPP-Ⅳ inhibitors+MET versusSU+MET). The hypoglycemia, OR,95%CI=0.13[0.09,0.19], p <0.00001(DPP-Ⅳ inhibitors+MET versus SU+MET). Compared DPP-Ⅳinhibitors therapy with comparators, the upper respiratory tract infection OR,95%CI=0.00[-0.01,0.01], p=0.49, the urinary tract infection OR,95%CI=0.97[0.70,1.34], p=0.83, nasopharyngitis OR,95%CI=1.07[0.94,1.21], p=0.30.Conclusions: DPP-Ⅳ inhibitors could achieve a long-term effectiveand safe glycaemic control. Add the DPP-Ⅳ inhibitor to the metformin forT2DM, instead of the sulfonylure，when the sulfonylurea is contraindicatedor not tolerated. There is no evidence that DPP-Ⅳ inhibitors increase therisk of infections.