Statistics from Altmetric.com
While reviewing abstracts in my role as an Evidence Based Medicine editor, I recently encountered a seemingly strange randomised trial of sitagliptin, one of the new dipeptidyl peptidase-4 (DPP-4) inhibitor antidiabetic drugs. Appearing in the New England Journal of Medicine, the trial evaluated the impact of sitagliptin on cardiovascular outcomes in patients with non-ideally controlled type 2 diabetes with established cardiovascular disease, concluding that sitagliptin was both non-inferior and non-superior to placebo in this high-risk group.1 As a primary care physician, my hope for diabetic patients of mine is that a new medication, such as sitagliptin, would be superior to placebo in reducing their high cardiovascular risk. However, in this high-risk population with prevalent cardiovascular disease, sitagliptin seemed to have no impact on cardiovascular outcomes over the median 3-year follow-up of the trial, so the clinical implications of the findings for my patients seemed dubious. I wondered why a trial demonstrating the non-inferiority of sitagliptin to placebo merited appearance in the world's highest impact general medical journal.
Of course, a trial such as this—the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS)—has a broader audience than front-line physicians. Indeed, on closer inspection, one suspects that …
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.