Linagliptin versus sitagliptin in patients with type 2 diabetes mellitus: a network meta-analysis of randomized clinical trials

Abstract

BackgroundDiabetes is one of the most common chronic and costly diseases worldwide and type 2 diabetes is the most common type which accounts for about 90% of cases with diabetes. New medication-therapy regimens such as those containing linagliptin alone or in combination with other medications (within the category of DDP-4 inhibitors) must be evaluated in terms of efficacy and compared with other currently used drugs and then enter the medication list of the country. Hence, this study aimed to compare the clinical efficacy of the two drugs, i.e. linagliptin and sitagliptin, in patients with type 2 diabetes.MethodsA systematic review was conducted to identify all clinical trials published by 2015 which compared the two drugs in patients with type 2 diabetes. Using keywords such as “linagliptin”, “type 2 diabetes mellitus”, “sitagliptin” and related combinations, we searched databases including Scopus, PubMed, and Web of Science. The quality of the selected studies was evaluated using the Jadad score. Considering primary and secondary outcomes extracted from the reviewed studies, a network meta-analysis was used to conduct a systematic comparison between the two studied drugs.ResultsThis network meta-analysis included 32 studies (Linagliptin vs PLB: n = 8, Sitagliptin vs PLB: n = 13, Linagliptin + MET vs PLB + MET: n = 4, and Sitagliptin + MET vs PLB + MET: n = 7) and a total of 13,747 patients. The results showed no significant difference between linagliptin and sitagliptin in terms of key efficacy and safety outcomes such as HbA1c changes from baseline, body weight change from baseline, percentage of patients achieving HbA1c <7, and percentage of patients experiencing hypoglycemic events (p > 0.05). The results showed that the efficacy of the two drug regimens was the same.ConclusionsBased on the results, there was no significant difference between the two drugs, i.e. linagliptin and sitagliptin, in terms of efficacy; in other words, the efficacy of the two drugs was the same. Therefore, the use of these two drugs depends on their availability and cost.Graphical abstractGraphical abstract of the network meta-analysis performed to evaluate the alternatives under the study. Electronic supplementary materialThe online version of this article (10.1186/s40199-017-0189-6) contains supplementary material, which is available to authorized users.

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“…One possible reason for the success of the sitagliptin-linagliptin formulary switch that was undertaken is the clinical similarity between these agents in terms of efficacy and safety. 5,6 Payers must also anticipate the potential clinical effect on all patients, including those stable on their current regimens, and properly communicate the switch prescribers. Providers frequently cite concerns with NMFS and purport that communication regarding these changes is suboptimal.…”

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“…Uncontrolled diabetes mellitus (DM) could lead to micro-/macrovascular complications, decreasing the quality of life, increasing the risk of premature death, and imposing a substantial economic burden of work absenteeism and healthcare on societies (1)(2)(3)(4)(5). The total annual cost of diabetes in Iran is estimated to 3.64 billion US dollars (including $1.71 billion direct and $1.93 billion indirect costs) in 2009, and is estimated to reach to 9 billion US dollars by 2030 (including $4.2 billion in direct and $4.8 billion in indirect costs) (1).…”

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