Background: The CAROLINA, landmark cardiovascular outcome trial (CVOT) , has demonstrated cardiovascular safety of glimepiride against DPP-IV inhibitor linagliptin. Considering the absence of CVOT for Gliclazide, we decided to conduct a systematic review of the literature to assess the cardiovascular (CV) safety and hypoglycemia risk of gliclazide versus linagliptin in patients with T2DM.
Method: A systematic literature search of MEDLINE and Google Scholar was conducted to include all linagliptin ± metformin and gliclazide ± metformin trials from 20onwards that assessed the adverse events: hypoglycemia, myocardial infarction/ischemia, transient ischemic attack, cardiovascular death, and stroke. Two independent reviewers conducted a literature search and study selection according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only randomized trials, considered the highest quality of evidence by the Oxford Center for Evidence-based Medicine, were included. We excluded placebo-controlled studies and studies comparing gliclazide or linagliptin with metformin.
Results: No trials compared gliclazide ± metformin with linagliptin ± metformin. Hence, it was impossible to directly compare their hypoglycemia and major adverse cardiovascular events (MACE) outcomes. Eight clinical trials were included in the narrative descriptive synthesis (gliclazide 5 and linagliptin 3) . Both drugs effectively achieved the desired glycaemic control and had low MACE and hypoglycemia risk in adults with T2DM. Studies comparing gliclazide with another DPP4 inhibitor, vildagliptin, did not report a significant difference in CV safety and/or hypoglycemia incidence.
Conclusion: Gliclazide can be used safely in patients with T2D in resource-limited settings as it has low MACE and hypoglycemia risk.
V.Mohan: None. S.Wangnoo: None. S.Das: n/a. R.Dhediya: None. K.Gaurav: Employee; Dr. Reddy’s Laboratories Ltd.
