Vildagliptin (Galvus) is an antihyperglycaemic agent that selectively inhibits the dipeptidyl peptidase-4 (DPP-4) enzyme. Such inhibition prevents the degradation of the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). This results in improved glycaemic control as determined by glycated haemoglobin (HbA(1c)) and fasting plasma glucose (FPG) levels, and, in addition, an enhancement of pancreatic alpha- and beta-cell function. Vildagliptin is indicated in the EU and elsewhere in the world for the management of type 2 diabetes mellitus in combination with metformin, a sulfonylurea or a thiazolidinedione in patients with inadequate glycaemic control following monotherapy. Vildagliptin is also available as a fixed-dose formulation with metformin (Eucreas).Oral vildagliptin in combination with metformin, a sulfonylurea or a thiazolidinedione improved glycaemic control in adults with type 2 diabetes and appeared to slow the progression of beta-cell degeneration in trials of 24-52 weeks' duration. In trials in patients with diabetes inadequately controlled with metformin, vildagliptin provided an additional reduction of HbA(1c) levels of 1.1% and was shown to be as effective as pioglitazone as add-on therapy in a noninferiority trial. Vildagliptin had a low risk of hypoglycaemia, was weight-neutral overall and was generally well tolerated. Further investigation is required to accurately position vildagliptin relative to other, well established antidiabetic agents. However, the addition of vildagliptin expands the range of treatment options available, and as such, offers further potential for the management of patients with type 2 diabetes that is inadequately controlled with monotherapy.
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