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

Michelle E Orme,1 Hiep Nguyen,2 Jackie Y Lu,3 Susan A Thomas3 1ICERA Consulting Ltd, Swindon, UK; 2AstraZeneca, Wilmington, DE, 3AstraZeneca, Fort Washington, PA, USABackground: Clinical studies of patients with type 2 diabetes show that GLP-1 receptor agonists (GLP-1 RAs) improve glycemic...

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Autores principales:	Orme ME, Nguyen H, Lu JY, Thomas SA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	type 2 diabetes glucagon-like peptide-1 receptor agonists GLP-1RAs network meta-analysis comparative effectiveness Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/8944c3ee3ac4449ebad66f703ecfd0d1
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spelling	oai:doaj.org-article:8944c3ee3ac4449ebad66f703ecfd0d12021-12-02T06:51:20ZComparative 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 trials1178-7007https://doaj.org/article/8944c3ee3ac4449ebad66f703ecfd0d12017-03-01T00:00:00Zhttps://www.dovepress.com/comparative-effectiveness-of-glycemic-control-in-patients-with-type-2--peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Michelle E Orme,1 Hiep Nguyen,2 Jackie Y Lu,3 Susan A Thomas3 1ICERA Consulting Ltd, Swindon, UK; 2AstraZeneca, Wilmington, DE, 3AstraZeneca, Fort Washington, PA, USABackground: 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 A1C target of <7% were analyzed with a binomial model and change in A1C from baseline with a normal model. A covariate analysis assessed the impact of baseline A1C and treatment background on outcomes. Results: The base-case NMA used 23 trials reporting A1C outcomes at ~6 month follow-up. The results, unadjusted and adjusted for baseline A1C, indicated that all GLP-1 RAs resulted in statistically significantly lower A1C 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 A1C 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% A1C target within 6 months of commencing GLP-1 RAs. Conclusion: This was a comprehensive assessment of the comparative effectiveness of GLP-1 RAs and A1C outcome. GLP-1 RAs are a viable addition to oral antidiabetes therapy, and dulaglutide, exenatide once weekly, and liraglutide are the most effective. Keywords: type 2 diabetes, glucagon-like peptide-1-receptor agonists, GLP-1 RAs, network meta-analysis, comparative effectivenessOrme MENguyen HLu JYThomas SADove Medical Pressarticletype 2 diabetesglucagon-like peptide-1 receptor agonistsGLP-1RAsnetwork meta-analysiscomparative effectivenessSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 10, Pp 111-122 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	type 2 diabetes glucagon-like peptide-1 receptor agonists GLP-1RAs network meta-analysis comparative effectiveness Specialties of internal medicine RC581-951
spellingShingle	type 2 diabetes glucagon-like peptide-1 receptor agonists GLP-1RAs network meta-analysis comparative effectiveness Specialties of internal medicine RC581-951 Orme ME Nguyen H Lu JY Thomas SA 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
description	Michelle E Orme,1 Hiep Nguyen,2 Jackie Y Lu,3 Susan A Thomas3 1ICERA Consulting Ltd, Swindon, UK; 2AstraZeneca, Wilmington, DE, 3AstraZeneca, Fort Washington, PA, USABackground: 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 A1C target of <7% were analyzed with a binomial model and change in A1C from baseline with a normal model. A covariate analysis assessed the impact of baseline A1C and treatment background on outcomes. Results: The base-case NMA used 23 trials reporting A1C outcomes at ~6 month follow-up. The results, unadjusted and adjusted for baseline A1C, indicated that all GLP-1 RAs resulted in statistically significantly lower A1C 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 A1C 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% A1C target within 6 months of commencing GLP-1 RAs. Conclusion: This was a comprehensive assessment of the comparative effectiveness of GLP-1 RAs and A1C outcome. GLP-1 RAs are a viable addition to oral antidiabetes therapy, and dulaglutide, exenatide once weekly, and liraglutide are the most effective. Keywords: type 2 diabetes, glucagon-like peptide-1-receptor agonists, GLP-1 RAs, network meta-analysis, comparative effectiveness
format	article
author	Orme ME Nguyen H Lu JY Thomas SA
author_facet	Orme ME Nguyen H Lu JY Thomas SA
author_sort	Orme ME
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_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_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_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
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/8944c3ee3ac4449ebad66f703ecfd0d1
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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

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