{"id":821,"date":"2015-09-02T14:34:59","date_gmt":"2015-09-02T14:34:59","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=821"},"modified":"2017-08-21T11:32:50","modified_gmt":"2017-08-21T11:32:50","slug":"primary-care-corner-with-geoffrey-modest-md-dpp-4-inhibitors-in-diabetics-and-severe-joint-pain","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/09\/02\/primary-care-corner-with-geoffrey-modest-md-dpp-4-inhibitors-in-diabetics-and-severe-joint-pain\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: DPP-4 Inhibitors in Diabetics and Severe Joint Pain"},"content":{"rendered":"<p><strong>By. Dr. Geoffrey Modest<\/strong><\/p>\n<p>The FDA just came out with a warning about\u00a0DPP-4 inhibitors causing severe joint pain (see\u00a0<a href=\"http:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm459579\">http:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm459579<\/a>\u00a0). They reviewed their FDA\u00a0Adverse Event Reporting System (FAERS) database and the medical literature and identified cases of severe joint pain associated with the use of DPP-4 inhibitors, with symptoms starting 1 day to years after starting the DPP-4 inhibitor, and relief of symptoms usually\u00a0within a month of stopping the med.<\/p>\n<p>Results:<\/p>\n<ul>\n<li>They identified 33 such cases, all resulting in &#8220;substantial reduction in their prior level of activity&#8221;, and\u00a010 of whom were hospitalized<\/li>\n<li>In 22 cases, the joint symptoms developed within one month of starting the med<\/li>\n<li>In 23, the symptoms resolved within a month of stopping the med<\/li>\n<li>8\u00a0had recurrent symptoms on rechallenge with DPP-4 inhibitor (6 of them with a different DPP-4 inhibitor)<\/li>\n<li>10 of the cases suggested an immunological reaction\u00a0with fever, chills, rash and swelling.<\/li>\n<li>8 of\u00a013 who had immunological testing had normal results, 2 with\u00a0positive ANA, 1 with increased ESR, 1 with increased CRP, and 1 with antinuclear cytoplasmic antibody (i.e., nonspecific)<\/li>\n<\/ul>\n<p>As a result, the FDA is\u00a0adding this\u00a0&#8220;Warning and Precaution&#8221;\u00a0to the drugs.<\/p>\n<p>DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors, which include sitagliptin, saxagliptin, linagliptin, and alogliptin) are newer agents used in the treatment of diabetes, and data on their efficacy in diabetes is based on their effect on HgbA1C levels (which is\u00a0pretty minimal at that!! \u00a0See blog from June 2015 \u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/06\/24\/primary-care-corner-with-geoffrey-modest-md-dpp-4-inhibitors-and-cardiovascular-outcomes\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/06\/24\/primary-care-corner-with-geoffrey-modest-md-dpp-4-inhibitors-and-cardiovascular-outcomes\/<\/a> which notes that A1c improves only\u00a0a little, and there is no cardiac protection, a primary clinical endpoint\u200b, even after 3 years in almost 15K people with average age of 66). So, from my perspective these meds are\u00a0expensive and minimally useful adjuncts to therapy at best, and not surprisingly lead to adverse effects (by blocking\u00a0DPP-4,\u00a0they effectively block a ubiquitous enzyme on the surface of most cells and deactivate\u00a0a variety of bioactive peptides).<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: DPP-4 Inhibitors in Diabetics and Severe Joint Pain  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/09\/02\/primary-care-corner-with-geoffrey-modest-md-dpp-4-inhibitors-in-diabetics-and-severe-joint-pain\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-821","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/821","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=821"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/821\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=821"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=821"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=821"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}