Assessing Consistency in a Network Meta-Analysis to Compare Once Weekly Dulaglutide Versus Other Glp-1 Receptor Agonists in Patients with Type 2 Diabetes

Efficacy and safety of long-acting glucagon-like peptide-1 receptor agonist dulaglutide in patients with type 2 diabetes: a systematic review and meta-analysis of 21 randomized controlled trials

OBJECTIVES

To assess the efficacy and safety of once weekly glucagon-like peptide-1 receptor agonist (GLP-1 RA) dulaglutide for the treatment of type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

We searched PubMed, Embase, and Cochrane Library from inception to August 18, 2019. Revman5.3 and Stata13.0 software were used for meta-analysis.

RESULTS

Twenty-one trials including 20,367 patients were analyzed. Compared with control group, hemoglobin A1c (HbA1c) in 0.75 mg dulaglutide group and 1.5 mg dulaglutide group were reduced by 0.29% and 0.55%, respectively. More patients treated with 0.75 mg dulaglutide [RR 1.24, 95% CI (1.08, 1.42), p = 0.002] and 1.5 mg dulaglutide [RR 1.66, 95% CI (1.40, 1.99), p < 0.00001] had reached the target of HbA1c 7.0%. In patients with T2DM, 0.75 mg dulaglutide and 1.5 mg dulaglutide had a statistically higher adverse events (AEs) incidence than control, whereas the risk of hypoglycaemia was lower in 0.75 mg dulaglutide group and 1.5 mg dulaglutide group than in control group.

CONCLUSIONS

Based on the current evidence, 0.75 and 1.5 mg dulaglutide are associated with better glycemic control and lower rate of hypoglycemia in patients with T2DM.

A Network Meta-analysis Comparing Exenatide Once Weekly with Other GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus

INTRODUCTION

Exenatide is a glucagon-like peptide-1 receptor agonist (GLP-1 RA), approved for treatment of type 2 diabetes mellitus (T2DM). There is limited direct evidence comparing the efficacy and tolerability of exenatide 2 mg once weekly (QW) to other GLP-1 RAs. A network meta-analysis (NMA) was conducted to estimate the relative efficacy and tolerability of exenatide QW versus other GLP-1 RAs for the treatment of adults with T2DM inadequately controlled on metformin monotherapy.

METHODS

A systematic literature review was conducted to identify randomized controlled trials (RCTs) that investigated GLP-1 RAs (albiglutide, dulaglutide, exenatide, liraglutide, and lixisenatide) at approved doses in the United States/Europe, added on to metformin only and of 24 ± 6 weeks treatment duration. A Bayesian NMA was conducted.

RESULTS

Fourteen RCTs were included in the NMA. Exenatide QW obtained a statistically significant reduction in glycated hemoglobin (HbA1c) relative to lixisenatide 20 µg once daily. No other comparisons of exenatide QW to other GLP-1 RAs were statistically significant for change in HbA1c. No statistically significant differences in change in weight, systolic blood pressure, risk of nausea or discontinuation due to adverse events were observed for exenatide QW versus other GLP-1 RAs.

CONCLUSION

Exenatide QW demonstrated similar effectiveness and tolerability compared to other GLP-1 RAs, for the treatment of T2DM in adults inadequately controlled on metformin alone.