Dipeptidyl peptidase 4 (DPP-4) inhibitors in patients with cirrhosis and diabetes

Background and Aim: DPP4 inhibitors have pleiotropic effects. Studies are limited on safety profile of DPP-4 inhibitors in patients with cirrhosis and diabetes. Aim is to study effect of DPP4 inhibitors on liver function tests in patients with diabetes and cirrhosis. Methods: All consecutive patients with cirrhosis and diabetes who were started on DPP4 inhibitors within one month were included. Patients’ liver functions tests and HbA1c were monitored every three months for 6 months. Patients were followed up monthly for any possible side effects related to DPP 4 inhibitors. Results: 57 patients (M:F: 37:20) were enrolled with mean age 59± 9 yrs, weight 72±12 kg, etiology NASH, n= 54(96%)[CTP A:B:C:41:16:0] with mean duration of diabetes 9±4 yrs. Mean Fibroscan was 36±16Kpa and 19(33%) patients had esophageal varices suggesting significant clinical portal hypertension.39(68%) patients were on sitagliptin,13(23%) vildagliptin, linagliptin n=4(175) and one(2%) was taking teneligliptin. 40 (70%) were taking metformin and 4(7%) were also taking SGLT-2 inhibitors. Nausea and bloating seen in 6(2%), non specific muscle pain in 3(1%), upper respiratory infection in 3(1%), acute pancreatitis, n=1. Conclusion: DPP-4 inhibitors are safe in patient with compensated cirrhosis and diabetes and did not affect liver function over a follow up of 6 months.