Alogliptin: a review of its use in the management of type 2 diabetes mellitus

Alogliptin (Nesina?) is a dipeptidyl peptidase-4 inhibitor that is approved in Japan for the treatment of adult patients with type 2 diabetes mellitus that is inadequately controlled by diet and exercise alone or by diet plus treatment with an α-glucosidase inhibitor. Alogliptin plus diet and exercise is also approved in Japan for use in combination with a thiazolidinedione in patients with type 2 diabetes. In several large (n >250), double-blind, multinational trials of up to 26 weeks' duration, oral alogliptin as monotherapy or in combination with other oral antihyperglycaemic agents (metformin, glibenclamide or pioglitazone) or insulin therapy improved glycaemic control and was generally well tolerated in adult patients with inadequately controlled type 2 diabetes, including elderly patients. Significant improvements in glycaemic control were evident from as early as 1 week in terms of improvements in mean fasting plasma glucose levels and from 4 weeks onwards for improvements in mean glycosylated haemoglobin levels. In general, the incidence of hypoglycaemia was similar to that seen in placebo groups and alogliptin treatment had neutral effects on bodyweight and lipid parameters. The long-term safety of alogliptin therapy remains to be established in clinical studies and with clinical experience. A planned clinical trial evaluating long-term clinical outcomes in patients with acute coronary syndrome and other planned or ongoing short-term trials will help to more definitively determine the position of alogliptin therapy in relation to other available antihyperglycaemic therapies. In the meantime, alogliptin is a promising new option for the treatment of patients with type 2 diabetes, including elderly patients.