Systematic review of clinical and economic effectiveness of vildagliptin in type 2 diabetic patients with poor glycemic control on monotherapy with metformin

Abstract

Aim: A study was conducted to assess the clinical and economic effectiveness of vildagliptin in adults with type 2 diabetes mellitus (T2DM) with poor glycemic control against the metformin monotherapy. Materials and methods: 280 sources were identified in accordance with the search strategy; 40 sources were subjected to critical analysis, of which 22 full-text publications were included in the present study. Results and discussion: Significant advantages of the use of vildagliptin in combination with metformin in improving glycemic control, regardless of the initial level of glycosylated hemoglobin (HbA1c), age or body mass index (BMI) compared with other dipeptidyl peptidase-4 inhibitors, were found; Combination therapy using 50 mg of vildagliptin and metformin twice daily significantly reduced the mean baseline HbA1c (-0.7 to -0.9%) and fasting blood glucose levels (-1.4 to 0.1 mmol/l) compared with placebo, as well as with other dipeptidyl peptidase-4 inhibitors; this combination also led to the greatest increase in QALYs (0.18 over the life span) among dipeptidyl peptidase-4 inhibitors compared to treatment with a combination of metformin and glimepiride. Thus, the combination of metformin and vildagliptin gives advantages in efficiency and additional mechanisms of action, since it does not increase the risk of hypoglycemia and does not contribute to weight gain.  Conclusion: Combination therapy using metmorfin and vildagliptin is more cost-effective, since it does not increase the risk of hypoglycemia and does not lead to increasing weight.

Keywords

• type 2 diabetes mellitus (T2DM)
• dipeptidyl peptidase-4 inhibitors
• efficacy
• safety