Exenatide or sitagliptin not linked to acute renal failure in diabetes

31 January 2012

MedWire News: Use of exenatide or sitagliptin in treating diabetes does not appear to be associated with an increased risk for acute renal failure (ARF) relative to use of metformin, sulfonylureas (SUs), or thiazolidinediones (TZDs), show study findings.

“Our study revealed an increased risk for ARF in diabetic versus nondiabetic patients but no association between use of exenatide or sitagliptin and ARF,” say Merri Pendergrass (University of Texas, Dallas, USA) and colleagues.

“The Food and Drug Administration (FDA) has recently added a warning about ARF to the labeling information of exenatide,” note the researchers in the journal Diabetes, Obesity and Metabolism.

In addition, cases of worsening renal function with sitagliptin have been reported, they write.

The authors say that, to their knowledge, the current study is the first to systematically evaluate the potential association between exenatide, sitagliptin, and ARF.

The team performed an analysis of medical and pharmacy claims stored on the Medco National Integrated Database for 491,539 patients.

Patients with diabetes who were on either metformin, a SU, or a TZD prior to starting a new antidiabetic medication between January 2008 and December 2009 were divided into three groups according to whether they had initiated exenatide (exenatide group), sitagliptin (sitagliptin group), or metformin, a SU, or a TZD, but not sitagliptin or exenatide (diabetic control group).

Nondiabetic patients who were not receiving any antidiabetic medication were included as a second control group.

The patients were then followed-up until December 2010 for occurrence of ARF, as defined by the International Classification of Diseases code 584.

The study revealed that the incident rates of ARF were higher in the diabetes groups than they were in the nondiabetic controls (1.13 vs 0.34 cases per 100 patient–years). However, the rates were similar in the diabetic control, exenatide, and sitagliptin groups (1.02, 0.94, and 1.31 cases per 100 patient–years, respectively).

Kaplan-Meier analysis showed that, among the patients with diabetes, the risk for ARF was not increased in patients who started exenatide or sitagliptin, compared with those who started other agents, at hazard ratios of 0.77 and 1.17, respectively.

Pendergrass and team say that although their analysis cannot rule out with certainty that an association between exenatide, sitagliptin, and ARF exists, it does suggest that exenatide and sitagliptin are very unlikely to be associated with a large increased risk for ARF.

“We believe these data provide valuable information for practicing clinicians weighing potential reported benefits versus risks, including the FDA warning of increased ARF,” they conclude.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

Diabetes Obes Metab 2012; Advance online publication