Lee_2026_Endocrinol.Diabetes.Metab_9_e70270

AIMS: While dipeptidyl peptidase-4 (DPP-4) inhibitors are commonly considered to have a class effect, emerging evidence suggests intra-class heterogeneity in pharmacological properties. For patients who fail to achieve target glycemic levels with initial DPP-4 inhibitors therapy, intra-class therapeutic interchange may offer an alternative to dose escalation or add-on therapy. This study evaluated the effectiveness of evogliptin, a novel and potent DPP-4 inhibitor with a unique binding structure, as a strategy for therapeutic optimization. MATERIALS AND METHODS: This follow-up analysis included patients with HbA1c <= 7.0% who had received metformin plus a DPP-4 inhibitor other than evogliptin for at least 12 weeks and were subsequently switched to evogliptin. Changes in HbA1c and target achievement at 12 and 24 weeks were assessed according to the initial DPP-4 inhibitors. Multivariable linear regression was performed to identify independent predictors of HbA1c reduction. Additional exploratory subgroup analyses were conducted according to demographic and baseline clinical characteristics. RESULTS: Among 770 patients in the effectiveness set, mean HbA1c decreased by -0.3% at 12 weeks and -0.5% at 24 weeks (p < 0.0001 for both). In the sitagliptin group, reductions were -0.5% and -0.6%, respectively (p < 0.0001). At 24 weeks, 25.8% and 50.5% of patients achieved HbA1c targets of < 6.5% and < 7.0%, respectively. CONCLUSIONS: Intraclass therapeutic interchange (ICTI) to evogliptin from other DPP-4 inhibitors was an effective and well-tolerated strategy for optimizing glycemic control. These findings suggest that intra-class therapeutic interchange could be an effective and well-tolerated strategy for optimizing glycemic control in a clinical setting. However, given the observational nature of this study, further controlled studies are needed to confirm these findings against a comparator group. TRIAL REGISTRATION: ClinicalTrials.gov NCT04326166.