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[Correspondence] EXAMINE: targeting risk and treatment in diabetes

Two common medical fallacies are that more is better and every drug in a class is the same (known as a class effect). The association of dipeptidyl peptidase-4 (DDP-4) inhibitors with an increased risk of heart failure is supported by the SAVOR-TIMI 53 (saxagliptin) and EXAMINE (alogliptin) trials.1,2 With the publication of the much anticipated TECOS trial,3 this adverse effect appears to not be a class effect because sitagliptin did not cause an increase in the risk of heart failure. All five available DPP-4 inhibitors have similarity of either a primary or secondary amine group, which contributes to electrostatic interactions with DPP-4.