DPP-4 inhibitors for type 2 diabetes may cause severe joint pain

Adr bulletein

by shinu.c

DPP-4 inhibitors for type 2 diabetes may cause severe joint pain

DPP-4 inhibitors are a class of prescription medicines that are used with diet and exercise to control high 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.

Medicines in the DPP-4 inhibitor class include sitagliptin, saxagliptin, linagliptin, and alogliptin. They are available as single-ingredient products and in combination with other diabetes medicines such as metformin.DPP-4 inhibitors lower blood sugar by helping the body increase the level of the hormone insulin after meals. Insulin helps move sugar from the blood into the tissues so the body can use the sugar to produce energy and keep blood sugar levels stable.

In addition to severe joint pain, other possible side effects of DPP-4 inhibitors include inflammation of the pancreas, low blood sugar when this class of medicines is combined with other prescription medicines used to treat diabetes, and allergic reactions.

FDA Adverse Event Reporting System  identified  33 cases of severe arthralgia reported with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors. Each case involved the use of one or more DPP-4 inhibitor. Sitagliptin was the most frequently reported, followed by saxagliptin, linagliptin , alogliptin, and vildagliptin . All 33 patients experienced arthralgia that resulted in a substantial reduction in their prior level of activity, including 10 patients who were hospitalized due to disabling joint pain.

In 22 cases, symptoms appeared within 1 month of initiation of treatment with a DPP-4 inhibitor. In 20  cases, the DPP-4 inhibitor was suspected as a possible cause of arthralgia and was discontinued within a month following the onset of symptoms. However, 8 cases reported a period of 44 days to 1 year between the onset of symptoms and discontinuation of the DPP-4 inhibitor. In 23 cases, symptoms resolved less than 1 month after discontinuation of the drug.

Reports of eight cases documented a positive rechallenge. In these eight cases, individuals discontinued treatment, experienced a resolution of symptoms, restarted therapy with a DPP-4 inhibitor (a different member of the class in six of the eight cases), experienced the reappearance of the arthralgia, and subsequently, experienced resolution of the symptoms when DPP-4 inhibitor therapy was again discontinued. Twenty-one of the 33 patients were treated for arthritis with drug therapies that included corticosteroids, nonsteroidal anti-inflammatory drugs, methotrexate, and immune-modulating drugs

Additional Information for Patients

·      Some patients who take the type 2 diabetes medicines called dipeptidyl peptidase-4 (DPP-4) inhibitors can develop joint pain that can be severe.

·      Contact your health care professional right away if you develop severe and persistent joint pain while taking one of these medicines. Do not stop taking your DPP-4 inhibitor medicine without first talking to your health care professional.

·      Talk to your health care professional if you have questions or concerns about your diabetes medicines.

·      Report side effects from DPP-4 inhibitors

Additional Information for Health Care Professionals

·      Severe and disabling joint pain has been reported with the use of dipeptidyl peptidase-4 (DPP-4 inhibitors). The time to onset of symptoms following initiation of drug therapy varied from 1 day to years. Patients experienced relief of symptoms upon discontinuation of the medication. Some patients had a recurrence of severe joint pain when restarted on either their original DPP-4 inhibitor medication or another DPP-4 inhibitor.

·      Consider DPP-4 inhibitors as a possible cause for any patient who presents with severe and persistent joint pain, and consider discontinuation of therapy with this class of drugs.

·      Report adverse events involving DPP-4 inhibitors