Brand Names of Saxagliptin and Alogliptin
Saxagliptin is marketed under the brand name Onglyza, while alogliptin is marketed under the brand name Nesina.
DPP-4 Inhibitor Class Overview
Saxagliptin and alogliptin belong to the dipeptidyl peptidase-4 (DPP-4) inhibitor class of medications used for treating type 2 diabetes. These medications work by:
- Inhibiting the DPP-4 enzyme that rapidly degrades incretin hormones
- Increasing circulating concentrations of active GLP-1 and GIP
- Enhancing insulin secretion and inhibiting glucagon secretion in a glucose-dependent manner 1
Saxagliptin (Onglyza)
Saxagliptin is a highly potent, reversible, competitive DPP-4 inhibitor 2. Key characteristics include:
- Once-daily oral administration due to its favorable pharmacokinetic profile 3
- Moderate glucose-lowering efficacy, reducing HbA1c by approximately 0.43-0.9% 4
- Generally weight-neutral effect 2
- Low risk of hypoglycemia when used as monotherapy 3
Important Safety Considerations
Saxagliptin has been associated with increased risk of heart failure hospitalization in the SAVOR-TIMI 53 trial 5. The American Heart Association and Heart Failure Society of America recommend using DPP-4 inhibitors with caution in patients at risk for heart failure 5.
Alogliptin (Nesina)
Alogliptin was approved for use in Japan under the trade name Nesina in 2010 6. Key characteristics include:
- Selective DPP-4 inhibitor that enhances insulin secretion in a glucose-dependent manner
- Similar efficacy profile to other DPP-4 inhibitors
- Generally well-tolerated with a favorable safety profile
Important Safety Considerations
Like saxagliptin, alogliptin showed a trend toward increased heart failure hospitalizations in the EXAMINE trial 5. Both medications now carry relevant warnings in their labels regarding this potential risk 5.
Clinical Implications
When considering these medications, healthcare providers should be aware that:
- Both medications require dose adjustment in patients with moderate to severe renal impairment 5
- They have a lower risk of hypoglycemia compared to sulfonylureas or insulin 5
- They are generally weight-neutral, unlike some other diabetes medications that cause weight gain 1
- Both medications should be used with caution in patients with heart failure or at risk for heart failure 5
Cost Considerations
According to 2019 pricing data, the median monthly costs for maximum approved daily doses were:
- Saxagliptin (5 mg): $490 (AWP), $392 (NADAC)
- Alogliptin (25 mg): $234 (AWP), $170 (NADAC) 5
This makes alogliptin (Nesina) a more cost-effective option within the same drug class.