Collaboration of alogliptin and pioglitazone: a double hit on the target

Abstract

Diabetes mellitus is not only a problem of hyperglycemia, but is also associated with severe cardiovascular disease and fatal outcomes. Currently, glucose-lowering drugs are considered not only as effective glucose-reducing agents, but also as cardiosafe or even cardioprotective agents. Fixed combinations of glucose-lowering drugs of various groups with combined mechanisms of pharmacological effects on glycemic levels are more effective than monotherapy. The reincarnation of thiazolidinediones has contributed to the creation of various variants of these combinations. The study of the pleiotropic effects of pioglitazone in the form of an effect on myocardial remodeling, as well as the identified antifibrotic and antiatherosclerotic properties, has opened up new opportunities for the use of this drug both in monotherapy and in combination with other hypoglycemic agents. In turn, the antiatherosclerotic properties of alogliptin have been proven in various studies. As a result, the combination of “pioglitazone/alogliptin” showed a significantly greater hypoglycemic effect than the individual use of these drugs, along with a proven cardioprotective effect, a low risk of hypoglycemia, improved pancreatic function and no increase in side effects. Despite the pharmacological differences between these drugs (in the form of different onset of action), in the end the combination of “pioglitazone/alogliptin” from a pharmacodynamic point of view shows higher effectiveness than each drug separately in the form of improved myocardial remodeling, reduced formation of fibrosis, slowed down the development of atherosclerosis, reduced activity of chronic inflammation. The combination of two drugs in one tablet improves patient adherence to treatment, making it more likely to achieve glycemic goals and prevent adverse cardiovascular outcomes.