Efficacy and safety of liraglutide versus sitagliptin both in combination with metformin in patients with type 2 diabetes

Abstract

Background:The aim of this systematic review was to evaluate the efficacy and safety of liraglutide versus sitagliptin both in combination with metformin in patients with type 2 diabetes and provide reference basis for rational use of clinical drugs.Methods:Several databases were searched, including Web of science, PubMed, Cochrane library, CNKI, and Wanfang database. Only randomized controlled trials (RCTs) of liraglutide versus sitagliptin both in combination with metformin up to 31 August 2016 were included. Data were extracted independently by 2 reviewers, and a fixed or random effects model were used to analyze outcomes that were expressed as odds ratio (OR) or mean difference (MD) and 95% confidence intervals (95% CIs) for different situations.Results:Five RCTs involving 1440 participants were included. Compared with sitagliptin combination with metformin group, participants’ treatment with 1.2 mg and 1.8 mg liraglutide with metformin could significantly lower the level of glycosylated hemoglobin (HbA1c) (P < .00001, MD = −0.35, 95% CI −0.51 to −0.20). Moreover, patients with 1.8 mg liraglutide group had significant body weight loss (P < .00001, MD = −1.12, 95% CI −1.54 to −0.70). However, there were no obvious differences in cutting down the systolic blood pressure and diastolic blood pressure between liraglutide-metformin and sitagliptin-metformin groups. The incidence of gastrointestinal problems was significantly higher than sitagliptin with metformin groups.Conclusion:The results of this meta-analysis indicated that Liraglutide added on to metformin therapy could significantly lower the level of HbA1c and increase body weight loss. Meanwhile, the adverse reactions such as gastrointestinal problems were common in the liraglutide treatment group. Thus, this will provide an important reference for the treatment of patients with type 2 diabetes.

Real-World Clinical Effectiveness and Cost Savings of Liraglutide Versus Sitagliptin in Treating Type 2 Diabetes for 1 and 2 Years

“…Liraglutide demonstrated superior glycemic control, greater weight loss, and better treatment satisfaction after 52 weeks as an add-on to metformin compared with another incretin-based therapy, sitagliptin [a dipeptidyl peptidase-4 (DPP-4) inhibitor] [ 9 ]. The findings were consistent with those observed at a shorter follow-up period [ 10 – 12 ], while gastrointestinal problems were common adverse reactions to liraglutide [ 13 ]. Based on data from the clinical trials, the annual mean cost per patient was estimated to be $5103–$6523 (2012 USD) lower with liraglutide than with sitagliptin to reach glycated hemoglobin (HbA1c) < 7.0% with no hypoglycemia or weight gain, and liraglutide was shown to be more cost-effective than sitagliptin after 5 years of use [ 14 , 15 ].…”

Understanding the glucoregulatory mechanisms of metformin in type 2 diabetes mellitus

“…This finding suggests that in mice, GLP1 secretion is not the predominant mechanism for the glucose lowering effect of metformin. Of note, incretin-based therapies are approved for use as add-ons to the first line metformin monotherapy to further amplify clinical outcomes, which supports the contribution of GLP1-independent mechanisms to the glucose-lowering impact of metformin 164 .…”

Real-world Effectiveness of Liraglutide vs. Sitagliptin Among Older Patients with Type 2 Diabetes Enrolled in a Medicare Advantage Prescription Drug Plan: A Retrospective Observational Study

“…A recent real-world study has also highlighted the longterm effectiveness of liraglutide in this population [12]. A meta-analysis also demonstrated the efficacy and safety of liraglutide compared with sitagliptin when combined with metformin [23]. Furthermore, various studies sourcing data from clinical trials and claims data demonstrated better cost-effectiveness of liraglutide compared with sitagliptin, with any increases in pharmacy costs associated with liraglutide being offset by decreases in other diabetes-related medical expenses [13][14][15][16].…”