Efficacy and safety of saxagliptin, a dipeptidyl peptidase-4 inhibitor, in hemodialysis patients with diabetic nephropathy: A randomized open-label prospective trial

- Saxagliptin (2.5 mg/day) improved glycated albumin (GA) in hemodialysis patients.
- Saxagliptin also improved hemoglobin A1c (HbA1c) and postprandial plasma glucose (PPG).
- Saxagliptin improved GA, HbA1c, and PPG as monotherapy and in combination therapy.
- Changes in GA, HbA1c, and PPG were greater in patients with higher baseline values.
- Saxagliptin was not associated with any adverse events in hemodialysis patients.

AimsSaxagliptin is a dipeptidyl peptidase-4 inhibitor that was approved in Japan for the treatment of type 2 diabetes in 2013. We examined its efficacy and safety in Japanese hemodialysis patients with diabetic nephropathy.MethodsIn this prospective, open-label, parallel-group study, Japanese hemodialysis patients were randomized to receive either oral saxagliptin (2.5 mg/day) or usual care (control group) for 24 weeks. Before randomization, patients received fixed doses of conventional antidiabetic drugs (oral drugs and/or insulin) for 8 weeks; these drugs were continued during the study. Endpoints included changes in glycated albumin (GA), hemoglobin A1c (HbA1c), postprandial plasma glucose (PPG), and adverse events.ResultsBoth groups included 41 patients. Mean GA, HbA1c, and PPG decreased significantly in the saxagliptin group (−3.4%, −0.6% [−7 mmol/mol], and −38.3 mg/dL, respectively; all P < 0.0001) but not in the control group (0%, −0.1% [−1 mmol/mol], and −3.7 mg/dL, respectively) (P < 0.0001, P < 0.001, and P < 0.0001, respectively). In saxagliptin-treated patients, the reduction in GA was significantly greater when saxagliptin was administered as monotherapy than in combination therapy (−4.2% vs. −3.0%, P = 0.012) despite similar baseline values (24.5% vs. 23.3%). Reductions in GA, HbA1c, and PPG were greater in patients whose baseline values exceeded the median (23.8% for GA, 6.6% for HbA1c, and 180 mg/dL for PPG). There were no adverse events associated with saxagliptin.ConclusionsSaxagliptin (2.5 mg/day) was effective and well tolerated when used as monotherapy or combined with other antidiabetic drugs in Japanese hemodialysis patients with type 2 diabetes.Clinical Trial Registration numberUMIN000018445.