No short-term renal benefits with linagliptin in early diabetic kidney disease
medwireNews: Linagliptin significantly improves glycemic control in individuals with type 2 diabetes and early-stage kidney disease, but fails to significantly ameliorate glomerular damage, show findings from the MARLINA-T2D trial.
This latter finding is contrary to that of a recent pooled analysis showing a 16% reduction in the risk for chronic kidney disease progression with the dipeptidyl peptidase-4 inhibitor, Per-Henrik Groop (Biomedicum Helsinki, Finland) and colleagues note in Diabetes, Obesity and Metabolism.
After 24 weeks of treatment with linagliptin, the average placebo-adjusted decrease in glycated hemoglobin (HbA1c) from baseline was a significant 0.60%. It fell 0.63% in the 182 patients randomly assigned to linagliptin, compared with 0.03% in the 178 patients assigned to placebo, from baseline values of 7.82% and 7.86%, respectively.
The placebo-adjusted time-weighted mean percentage decrease in urinary albumin-to-creatinine (UACR) was not significant, however, at 6.0%, from average pretreatment values of 120.5 mg/g in the linagliptin group and 132.2 mg/g in the placebo group.
Linagliptin’s effect on kidney function is therefore more likely to be mediated through albuminuria-associated mechanisms such as endothelial dysfunction, podocyte damage, or mesangial proliferation, says the team. They also add that any renoprotective effect of the drug is more likely to prevent kidney disease progression over the long- rather than the short-term.
“The long-term effect of linagliptin on hard renal outcomes remains to be determined in the ongoing CARMELINA study,” the researchers point out.
By Lucy Piper
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