Nesina, a New DPP-4 Inhibitor for Diabetes

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NesinaNesina, generic alogplitin, is a new medication for Type II diabetes. It is generally meant to be used when the diabetes is not properly controlled, generally by metformin, but has been tested with a variety of medications and by itself alone.

It is part of a new generation of diabetes medications that works in a different way, particularly on the incretin system, than previous meds.

Most importantly, studies have shown Nesina may lower HbA1c levels as well as fasting plasma glucose levels while being at low risk of causing weight gain or hypoglycemia.

Mechanism of Action

Nesina is a DPP-4 inhibitor, which means that it acts to block the action of this enzyme inside your body. By doing so, Nesina raises the level of GLP-1, or glucagon-like peptide, which plays a variety of roles.

The increased level of GLP-1 does a variety of things. It enhances the ability of glucose to stimulate the release of insulin, which can then digest it.

GLP-1 also suppresses the release of glucagon, a hormone which increases glucose production and levels. Additionally, it also delays gastric emptying and promotes the health of beta cells in the pancreas.

Efficacy

Studies have shown that Nesina offers decent efficacy at lowering HbA1c levels as well as fasting plasma glucose levels.

HbA1c is a measure of blood that shows how much it is glycosylated over a period of time. This measure tends to reflect the average blood sugar in the blood and is often elevated in diabetes patients. Lowering it is a sign that blood sugar is better controlled.

In one meta analysis, which looked at results over multiple clinical trials, Nesina along with metformin showed the following results over a period of months:

  • Nesina 12.5mg + Metformin around a 1.11 to a .51 drop in HbA1c
  • Nesina 25mg + Metformin around a 1.3 to .66 drop in HbA1c

Another study of 288 diabetics, centered in Japan, found the following data, also looking at fasting plasma glucose, or FPG:

  • Nesina 12.5mg + Metformin around a .55 drop in HbA1c and a 19 mg/dl FPG drop
  • Nesina 25mg + Metformin around a .64 drop in HbA1c and a 23.1 mg/dl FPG drop
  • Metformin alone, a .22 increase in HbA1c and a 0.8 mg/dl FPG drop

These and other data support the efficacy of Nesina.

Side Effects/Concerns

The main concern around Nesina is that inhibition of DPP-4 may affect other systems in the body beyond GLP-1. In particular, the possibility of increased risk of infection or pancreatitis has been raised.

That said, studies have been run which show little risk from DPP-4 inhibition. In particular, one study looked at more than 8,000 patients on another DPP-4 inhibitor, vildagliptin.

That study found no increase in a variety of risks like hepatic events, pancreatitis, infection and adverse skin lesions.

This data supports the safety of Nesina.

The FDA did not initially approve Nesina when Takeda Pharmaceutical Company applied for it because it wanted more data on cardiovascular risks. It received this data and did approve the medication.

Summary

The data support Nesina as a new DPP-4 inhibitor for the treatment of diabetes. Importantly, it has shown the ability to lower HbA1c levels as well as fasting plasma glucose.

Additionally, it has shown little risk of causing weight gain or hypoglycemia.

These benefits, along with a decent side effect profile, make it a valuable new treatment option.

Sources:

Efficacy of alogliptin in type 2 diabetes treatment: a meta-analysis of randomized double-blind controlled studies

Alogliptin: a new addition to the class of DPP-4 inhibitors

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Pharmaceutical analyst who loves blogging about health and medical issues. Has written more than 150 articles and a book on attention deficit disorder. Correctly predicted delayed approval of Bydureon, approval of Provenge by FDA, and the non-approval of Acthar on June 11.

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