INTRODUCTION: For people with type 2 diabetes (T2D), combination therapy with a basal insulin and a glucagon-like peptide 1 receptor agonist (GLP-1 RA) can improve glycaemic control, lower hypoglycaemia risk, and improve adherence. IcoSema is the first once-weekly combination of basal insulin and GLP-1 RA in a single injection. To compare once-weekly IcoSema and once-daily IDegLira for the management of T2D in the absence of head-to-head trials, we performed a network meta-analysis (NMA).
METHODS: A systematic literature review was conducted in November 2023, updated in August 2025, to identify randomised controlled trials (RCTs) of people with T2D, investigating basal insulin and GLP-1 RA combination therapies. Data were extracted for change from baseline in glycated haemoglobin (HbA), body weight, systolic blood pressure, end-of-treatment basal insulin dose, rate ratio (RR) of clinically significant or severe hypoglycaemia and discontinuation due to adverse events (DDAEs). The NMA scope included multinational RCTs with evidence at 52 ± 4 weeks. Fixed and random effects Bayesian NMAs were fitted. 1c
RESULTS: At 52 weeks, compared with IDegLira, IcoSema was associated with significantly greater HbAreduction (- 0.4%; 95% credible interval [CrI] - 0.56, - 0.24), significantly greater body weight reduction (- 3.2 kg; 95% CrI - 3.91, - 2.5), significantly lower daily insulin dose (- 9 units/day; 95% CrI - 13, - 5) and significantly lower rates of clinically significant or severe hypoglycaemia (RR 0.35; 95% CrI 0.26, 0.46). There was no difference in the odds of DDAEs. No 52 ± 4-week IGlarLixi trials were identified. 1c
CONCLUSION: These results indicate that once-weekly IcoSema is an efficacious treatment option for adults with T2D requiring insulin intensification. IcoSema was associated with improved glycaemic control, weight reduction, and lower hypoglycaemia risk compared with once-daily IDegLira, as well as a reduction in insulin and injection requirements. Weekly IcoSema offers the potential to reduce treatment burden and increase adherence, thereby improving long-term disease control and patient outcomes.
