[en] Alogliptin (Vipidia) is a new selective inhibitor of dipeptidyl peptidase-4. By potentiating insulin secretion and by inhibiting glucagon secretion, both in a glucose-dependent manner, it improves glucose control of type 2 diabetic patients, without increasing the risk of hypoglycaemia and inducing weight gain, with an excellent clinical and biological tolerance. Both efficacy and safety have been demonstrated in randomised controlled trials, in monotherapy or in combination with other oral antidiabetic agents or even insulin. These results were obtained independently of clinical or demographic patient characteristics, including in elderly subjects and in patients with renal insufficiency. However, because alogliptin is eliminated through the kidneys, the usual dose of 25 mg once daily should be reduced to 12.5 mg per day in case of moderate renal impairment and to 6.25 mg per day in case of severe renal failure. Cardiovascular safety of alogliptin has been demonstrated in a large prospective study (EXAMINE) showing non-inferiority versus placebo in type 2 diabetic patients following an acute coronary syndrome. [fr] L’alogliptine (Vipidia®) est un nouvel inhibiteur sélectif de la dipeptidyl peptidase-4. En augmentant la sécrétion d’insuline et en réduisant la sécrétion de glucagon de façon gluco-dépendante, elle améliore le contrôle glycémique du patient diabétique de type 2, sans accroître le risque hypoglycémique, sans augmenter le poids corporel et avec une bonne tolérance clinique et biologique. Cette efficacité et cette sécurité ont été démontrées dans des essais cliniques contrôlés, en monothérapie ou en association avec d’autres antidiabétiques oraux et même avec l’insuline. Ces données ont été obtenues indépendamment des caractéristiques démographiques et cliniques des patients, y compris dans la population âgée ou avec insuffisance rénale. Cependant, comme l’alogliptine est éliminée par le rein, la posologie usuelle de 25 mg une fois par jour doit être réduite à 12,5 mg par jour en cas d’insuffisance rénale modérée et à 6,25 mg par jour en cas d’insuffisance rénale sévère. La sécurité cardiovasculaire de l’alogliptine a été démontrée dans une grande étude prospective de non-infériorité versus placebo chez des patients diabétiques de type 2 dans les suites d’un syndrome coronarien aigu, l’étude EXAMINE.
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