Le medicament du mois. Vildagliptine (Galvus) et combinaison fixe vildagliptine-metformine (Eucreas) dans le traitement du diabete de type 2.

Vildagliptin (Galvus) is a selective inhibitor of dipeptidylpeptidase-4, an enzyme involved in the metabolism of glucagon-like peptide-1 (GLP-1) secreted by L cells of the intestine. It potentiates the insulin secretory response (incretin effect) by enhancing the endogenous post-prandial response of GLP-1 (incretin enhancer) in a glucose-dependent manner. Vildagliptin is indicated in the treatment of type 2 diabetes. It improves blood glucose control (HbA1c) in patients treated by diet alone, metformin, sulfonylurea, glitazone or insulin. In patients not well controlled with metformin alone, the addition of vildagliptin is as effective in reducing HbA1c as the coadministration of glimepiride or pioglitazone. Tolerance of vildagliptin is excellent, with no weight gain and no hypoglycaemic episodes. Treatment is simple, with two doses of 50 mg per day, without need of titration or home blood glucose monitoring. In Belgium, vildagliptin is currently reimbursed for the treatment of type 2 diabetes after diet failure and monotherapy with metformin. Therapy can be administered separately or by using a fixed combination vildagliptin-metformin (Eucreas), which should improve drug compliance.