Comment on: “Pharmacokinetics in Patients with Chronic Liver Disease and Hepatic Safety of Incretin-Based Therapies for the Management of Type 2 Diabetes Mellitus”

Excerpt

The debate on alogliptin hepatotoxicity has recently aroused interest after a narrative review on hepatic safety of incretin-based therapies [1]. In fact, Scheen concluded that the overall liver safety of dipeptidyl peptidase-4 inhibitors (DPP-4-I) is reassuring, with the explicit statement that “no hepatotoxicity has been reported in the development programme of alogliptin”. In contrast, Barbehenn et al. [2] questioned these conclusions by detailing the US FDA hepatological assessment and perusing data from the Examination of Cardiovascular Outcomes with Alogliptin Versus Standard of Care (EXAMINE) trial, where a numerical imbalance, albeit not statistically significant, emerged for alogliptin [3]. The updated data provided by Scheen [4] indicate that “alogliptin is associated with a low risk of hepatic toxicity” and challenge the FDA liver panel test before starting alogliptin therapy. …