SAFETY PROFILE OF DIPEPTIDYL PEPTIDASE-4 INHIBITORS

Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) are oral antidiabetic agents commonly used for the treatment of type 2 diabetes mellitus. More than ten years of clinical experience with this group of drugs provides evidence of their efficacy and good tolerability especially in patients at risk of hypoglycemia. DPP-4 inhibitors act by increasing the levels of the incretins glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) and thus augmenting glucose-induced insulin secretion. The enzyme DPP-4 degrades plenty of substrates including chemokines, cytokines, and neuropeptides. Thus the inhibition of DPP-4 may affect many biological and pathological processes. Although rarely DPP-4 inhibitors have been reported to induce the development of infections, heart failure, liver injury and pancreatitis. The long-term effects of DPP-4 inhibition on the immune function are still not clarified. The close monitoring of polymorbid patients using DPP-4 inhibitors, and the reporting of possible adverse reactions associated with these drugs is warranted.