Evidence from 54 studies involving 23,209 patients shows that all GLP-1 receptor agonist regimens except liraglutide 0.3 mg once weekly significantly lowered hemoglobin A1c after 24-30 weeks compared with placebo.
Dulaglutide 0.75 mg QW, dulaglutide 1.5 mg QW, exenatide 2 mg QW, and several liraglutide regimens demonstrated significant reductions in hemoglobin A1c levels.
No regimen significantly outperformed dulaglutide 0.75 mg QW, dulaglutide 1.5 mg QW, or various liraglutide doses in lowering hemoglobin A1c.
The effects of GLP-1RAs on blood pressure, weight, and lipid levels were varied and not consistently significant.
Safety profiles regarding hypoglycemia and adverse events were comparable among the different GLP-1RA regimens.
Simplified
INTRODUCTION: The present study aimed to evaluate the effects of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on clinical and safety outcomes including glycemic control and cardiometabolic indicators using network meta-analysis.
METHODS: MEDLINE, Embase, and Cochrane Library Central Register of Controlled Trials were searched from inception through June 30, 2019. Randomized clinical trials comparing one or more of six eligible GLP-1RAs with placebo or another eligible were identified. We further screened studies that had 24-30 week follow-up periods and target endpoints. The primary outcome was change in hemoglobin A(HbA). Secondary outcomes included additional glycemic control indicators, cardiometabolic measures, and adverse events. Frequentist random-effect network meta-analyses were conducted for effect comparison. 1c1c
RESULTS: The NMA synthesized evidence from 54 studies covering 23,209 patients and 18 GLP-1RA regimens. All included GLP-1RA regimens except liraglutide 0.3 mg once weekly (QW) significantly lowered HbAafter 24-30 weeks compared with placebo. The pairwise comparison of HbA-lowering effect showed that dulaglutide 0.75 mg QW, dulaglutide 1.5 mg QW, exenatide 2 mg QW, liraglutide 0.9 mg QW, liraglutide 1.2 mg QW, liraglutide 1.8 mg QW, loxenatide 100 µg QW, and loxenatide 200 µg QW were not significantly outperformed by any of the other regimens. The effects on blood pressure, weight, and lipids were relatively mixed. The GLP-1RA regimens had comparable safety profiles with regard to hypoglycemia and adverse events. 1c1c
CONCLUSION: Regimens of GLP-1RAs had differential glycemic control and cardiometabolic effectiveness. Policymaking and patient-centric clinical decisions should take into consideration the comparative effectiveness profiles.
Key numbers
23,209
Patients Included
Total number of patients across 54 studies.
9 of 10
Significant Reduction
Regimens significantly lowering after 24-30 weeks.
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