Effectiveness and safety of vildagliptin and vildagliptin add-on to metformin in real-world settings in Egypt - results from the GUARD study

Objective: The GUARD study evaluated the effectiveness, safety, and tolerability of vildagliptin treatment with or without metformin in patients with type 2 diabetes mellitus (T2DM) in real-life settings. Here we present the results of the GUARD study for the patient subset from Egypt.Research design and methods: This was a 246 weeks, prospective, non-interventional study that enrolled adult patients with T2DM receiving vildagliptin or vildagliptin+metformin combination therapy as per local prescribing information.Main outcome measures: The primary effectiveness endpoint was change in HbA1c levels from baseline to week 246 endpoint. Safety was assessed by reporting of adverse events and serious adverse events (SAEs).Results: Of 2786 patients enrolled from Egypt, 655 received vildagliptin and 2131 received vildagliptin+metformin. Overall, at baseline, mean (+/- standard deviation [SD]) age was 49.5 +/- 9.49 years, BMI was 31.5 +/- 4.85kg/m(2), HbA1c was 8.4 +/- 0.86%, and duration of T2DM was 2.3 +/- 3.78 years. At week 24, significant reductions in mean (+/- SD) HbA1c were observed in the vildagliptin (-1.47 +/- 0.79%) and vildagliptin+metformin (-1.62 +/- 0.82%) groups (both p<0.0001) from baseline HbA1c of 8.1% and 8.4%, respectively. At week 24, 67.5% patients in the vildagliptin group and 60.5% in the vildagliptin+metformin group achieved HbA1c 7.0%. Treatment with vildagliptin (+/- metformin) was well tolerated, with a low incidence of hypoglycemia in both groups (vildagliptin, 0.5%; vildagliptin+metformin, 0.6%). No SAEs or deaths were reported in the vildagliptin group; however, 0.2% of patients experienced SAEs and one death (accidental death) was reported in the vildagliptin+metformin group.Conclusion: In a real-world setting, vildagliptin, with or without metformin, resulted in significant reductions in HbA1c and was well tolerated in patients with T2DM from Egypt. Limitations of the study include non-randomization and the open-label, observational nature of the study.