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Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials
BACKGROUND: Clinical studies of patients with type 2 diabetes show that GLP-1 receptor agonists (GLP-1 RAs) improve glycemic control and promote weight loss. We conducted a Bayesian network meta-analysis (NMA) of placebo- and active-controlled randomized trials to assess the comparative effectivenes...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove Medical Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386609/ https://www.ncbi.nlm.nih.gov/pubmed/28435304 http://dx.doi.org/10.2147/DMSO.S116810 |
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author | Orme, Michelle E Nguyen, Hiep Lu, Jackie Y Thomas, Susan A |
author_facet | Orme, Michelle E Nguyen, Hiep Lu, Jackie Y Thomas, Susan A |
author_sort | Orme, Michelle E |
collection | PubMed |
description | BACKGROUND: Clinical studies of patients with type 2 diabetes show that GLP-1 receptor agonists (GLP-1 RAs) improve glycemic control and promote weight loss. We conducted a Bayesian network meta-analysis (NMA) of placebo- and active-controlled randomized trials to assess the comparative effectiveness of liraglutide, albiglutide, dulaglutide, and exenatide twice daily and once weekly, with a focus on glycemic control. MATERIALS AND METHODS: We searched Medline, Embase, and the Cochrane Library (up to December 2014) for core registration programs for US-approved GLP-1 RAs. Patients reaching an A(1C) target of <7% were analyzed with a binomial model and change in A(1C) from baseline with a normal model. A covariate analysis assessed the impact of baseline A(1C) and treatment background on outcomes. RESULTS: The base-case NMA used 23 trials reporting A(1C) outcomes at ~6 month follow-up. The results, unadjusted and adjusted for baseline A(1C), indicated that all GLP-1 RAs resulted in statistically significantly lower A(1C) at follow-up compared with placebo. The odds of reaching the <7% target were also significantly better compared with placebo. With dulaglutide, exenatide once weekly, and liraglutide, the absolute reduction in A(1C) at 6 months was 0.9%–1.4%, and was significantly better than exenatide twice daily. Albiglutide was not significantly different from exenatide twice daily. We estimate that ~50% of patients will meet the <7% A(1C) target within 6 months of commencing GLP-1 RAs. CONCLUSION: This was a comprehensive assessment of the comparative effectiveness of GLP-1 RAs and A(1C) outcome. GLP-1 RAs are a viable addition to oral antidiabetes therapy, and dulaglutide, exenatide once weekly, and liraglutide are the most effective. |
format | Online Article Text |
id | pubmed-5386609 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-53866092017-04-21 Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials Orme, Michelle E Nguyen, Hiep Lu, Jackie Y Thomas, Susan A Diabetes Metab Syndr Obes Original Research BACKGROUND: Clinical studies of patients with type 2 diabetes show that GLP-1 receptor agonists (GLP-1 RAs) improve glycemic control and promote weight loss. We conducted a Bayesian network meta-analysis (NMA) of placebo- and active-controlled randomized trials to assess the comparative effectiveness of liraglutide, albiglutide, dulaglutide, and exenatide twice daily and once weekly, with a focus on glycemic control. MATERIALS AND METHODS: We searched Medline, Embase, and the Cochrane Library (up to December 2014) for core registration programs for US-approved GLP-1 RAs. Patients reaching an A(1C) target of <7% were analyzed with a binomial model and change in A(1C) from baseline with a normal model. A covariate analysis assessed the impact of baseline A(1C) and treatment background on outcomes. RESULTS: The base-case NMA used 23 trials reporting A(1C) outcomes at ~6 month follow-up. The results, unadjusted and adjusted for baseline A(1C), indicated that all GLP-1 RAs resulted in statistically significantly lower A(1C) at follow-up compared with placebo. The odds of reaching the <7% target were also significantly better compared with placebo. With dulaglutide, exenatide once weekly, and liraglutide, the absolute reduction in A(1C) at 6 months was 0.9%–1.4%, and was significantly better than exenatide twice daily. Albiglutide was not significantly different from exenatide twice daily. We estimate that ~50% of patients will meet the <7% A(1C) target within 6 months of commencing GLP-1 RAs. CONCLUSION: This was a comprehensive assessment of the comparative effectiveness of GLP-1 RAs and A(1C) outcome. GLP-1 RAs are a viable addition to oral antidiabetes therapy, and dulaglutide, exenatide once weekly, and liraglutide are the most effective. Dove Medical Press 2017-03-29 /pmc/articles/PMC5386609/ /pubmed/28435304 http://dx.doi.org/10.2147/DMSO.S116810 Text en © 2017 Orme et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Orme, Michelle E Nguyen, Hiep Lu, Jackie Y Thomas, Susan A Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
title | Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
title_full | Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
title_fullStr | Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
title_full_unstemmed | Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
title_short | Comparative effectiveness of glycemic control in patients with type 2 diabetes treated with GLP-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
title_sort | comparative effectiveness of glycemic control in patients with type 2 diabetes treated with glp-1 receptor agonists: a network meta-analysis of placebo-controlled and active-comparator trials |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386609/ https://www.ncbi.nlm.nih.gov/pubmed/28435304 http://dx.doi.org/10.2147/DMSO.S116810 |
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