Prof. Groop (Helsinki, Finland)

Although we focus a lot on the presence of CV disease and heart failure, we still need additional glycaemic control and improved glycaemic control. The good news here is that by using linagliptin, we can actually – irrespective of comorbidities or clinical characteristics – we can improve glycaemic control.

In 2011, we had this medication approved and now we are celebrating 10 years of the use of linagliptin.

And again, I would like to highlight that it is very easy to use linagliptin because you can use and expect significant A_1c reductions in the same ballpark of 0.6–0.8%, irrespective of age, duration of diabetes, kidney or hepatic function, ethnicity or background therapy. So, this makes it very, very simple.

Then we have these two unique trials: CARMELINA® and CAROLINA®; two sisters that have provided evidence for CV and kidney safety in a broad range of patients. CAROLINA®: early stage; CARMELINA® at late stage, very sick patients.

Linagliptin is unique because it’s not excreted via the kidneys so you don’t see accumulation of the drug and that is also good news because you don’t have to adjust the dose. Linagliptin is excreted by the bile and gut; however, unchanged so it is not metabolised. And that is also the reason we can use it in those with hepatic impairment.

I think [it is] very important also at this stage to point out that we also have a lot of experience with linagliptin already: more than 17 million patient-years’ exposure worldwide in 10 years, and that, of course, is reassuring.

And also let me show this slide, linagliptin is the only one with two CVOTs, unique ones, one with very sick patients (CARMELINA®), one with active comparator glimepiride [CAROLINA®] and you can see that shows CV safety. Linagliptin is the only one that also showed kidney safety and that was shown in CARMELINA®. And also, in CARMELINA® , in very sick patients with a lot of patients with heart failure at baseline, no increased risk of ending up in hospital because of HF: very, very good news.

Then the question is: are there patients with T2D in practice who could benefit from the simplicity of linagliptin? I’m pretty sure there are because you can use it, as I said, irrespective of any of the clinical characteristics that I was showing earlier.

So, to sum up: linagliptin has the highest DPP4 inhibition potency in the class, very similar A_1c reduction levels as the others and unique convenience: one dose, once daily. Efficacy and safety data available in a broad range of patients and also, remarkably, two CVOTs and the only one with two unique studies, I reiterate myself, demonstrated CV safety profile. No increased risk of HHF and, being a nephrologist here, it’s the only DPP inhibitor with a demonstrated kidney safety profile in the CARMELINA® trial.