Gliptins are a novel class of oral anti-diabetic agent that enhance and prolong the physiological actions of incretin hormones by competitively antagonising the enzyme DPP-4.
If you are suffering from type 2 diabetes and taking any of the gliptins such as sitagliptin or saxagliptin, consult your doctor soon if you complain severe joint pain.
The US drug regulator, Food and Drug Administration (FDA), has warned that that the type 2 diabetes medicines sitagliptin, saxagliptin, linagliptin, and alogliptin may cause joint pain that can be severe and disabling. It has added a new warning and precaution about this risk to the labels of all medicines in this drug class, called dipeptidyl peptidase-4 (DPP-4) inhibitors.
Gliptins are a novel class of oral anti-diabetic agent that enhance and prolong the physiological actions of incretin hormones by competitively antagonising the enzyme DPP-4.
DPP-4 inhibitors are used along with diet and exercise to lower blood sugar in adults with type 2 diabetes. When untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease. These medicines are available as single-ingredient products and in combination with other diabetes medicines such as metformin.
Some of the DPP-4 inhibitors are Januvia (sitagliptin), Janumet (sitagliptin and metformin) and Janumet XR (sitagliptin and metformin extended release) manufactured by US-based Merck & Co, known as MSD in India. The other brands are Onglyza (saxagliptin) by AstraZeneca, Kombiglyze XR (saxagliptin and metformin extended release) by Bristol-Myers Squibb, Tradjenta (linagliptin) by Boehringer Ingelheim, Glyxambi (linagliptin and empagliflozin) and Jentadueto (linagliptin and metformin) by Boehringer Ingelheim and Eli Lilly, Nesina (alogliptin), Kazano (alogliptin and metformin) and Oseni (alogliptin and pioglitazone) by Takeda Pharmaceutical.
Some of these brands like Januvia, Janumet, Onglyza, Kombiglyze and Trajenta are available and prescribed by physicians in India.
According to FDA, patients should not stop taking their DPP- 4 inhibitor medicine, but should contact their healthcare professional right away if they experience severe and persistent joint pain. Healthcare professionals should consider DPP-4 inhibitors as a possible cause of severe joint pain and discontinue the drug if appropriate, it said.
US FDA said it has identified cases of severe joint pain associated with the use of DPP-4 inhibitors. Patients started having symptoms from Day 1 to years after they started taking a DPP-4 inhibitor. After the patients discontinued the DPP-4 inhibitor medicine, their symptoms were relieved, usually in less than a month. Some patients developed severe joint pain again when they restarted the same medicine or another DPP-4 inhibitor.
While the US regulator has asked the US healthcare providers to discontinue these inhibitors in case patients come with complaints, the same may not be the case in India.
According to an industry expert, healthcare professionals in India also promote these medicines.
Januvia and Janumet are the most popular among the DPP-4 inhibitors available in India. "The size of MSD's Januvia and Janumet in India would be around Rs 350-400 crore, while that for Tradjenta by Boehringer would be around Rs 50-80 crore. For Onglyza and Kombiglyze, the market size are around Rs 35-40 crore each," said a pharma analyst.
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