Evaluation and comparison of efficacy and safety of tirzepatide, liraglutide and SGLT2i in patients with type 2 diabetes mellitus: a network meta-analysis

📖 Top 20% JournalDec 24, 2024BMC endocrine disorders

Comparing how well tirzepatide, liraglutide, and SGLT2 inhibitors control type 2 diabetes and their safety

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Abstract

Tirzepatide 15 mg reduced HbA1c levels by 2.24% compared to placebo in a study involving 8499 participants.

All treatments improved HbA1c levels compared to placebo, with tirzepatide showing the greatest reduction.
Tirzepatide also resulted in significant weight loss, with tirzepatide 15 mg leading to a reduction of 8.74 kg compared to placebo.
Canagliflozin 300 mg was associated with the largest decrease in systolic blood pressure at -5.96%.
Henagliflozin 5 mg demonstrated the most significant reduction in diastolic blood pressure, with a decrease of -2.46%.
Liraglutide 1.8 mg was most likely to cause adverse events, though no significant differences in serious adverse events were observed among the treatments.

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OBJECTIVE: The objective is to assess the effectiveness and safety of tirzepatide, liraglutide, and SGLT2i in individuals diagnosed with type 2 diabetes.

METHODS: An inquiry was undertaken within the electronic database spanning from its inception to February 11th, 2024, aimed at identifying randomized controlled trials that assess the efficacy and safety of tirzepatide, liraglutide, canagliflozin, ertugliflozin, empagliflozin, dapagliflozin, and henagliflozin. Perform a network meta-analysis to examine the distinctions among them (PROSPERO registration number: CRD42024537006).

RESULTS: Twenty-eight RCTs were included, involving 8499 participants. Compared with placebo, all treatments improved HbA1c levels: tirzepatide 15 mg reduced HbA1c the most (MD [95% CI], -2.24% [-2.52, -1.96]%), followed by tirzepatide 10 mg (MD [95% CI], -1.99% [-2.29, -1.69]%), tirzepatide 5 mg (MD [95% CI], -1.82% [-2.11, -1.53]%), and liraglutide 1.2 mg (MD [95% CI], -1.23% [-1.41, -1.05]%). Canagliflozin 300 mg also showed a significant reduction in HbA1c (MD [95% CI], -1.00% [-1.18, -0.82]). Tirzepatide was also the most effective in promoting weight loss, with the following results compared with placebo: tirzepatide 15 mg (MD [95% CI], -8.74 kg [-9.83, -7.66] kg), tirzepatide 10 mg (MD [95% CI], -7.13 kg [-8.40, -5.88] kg), tirzepatide 5 mg (MD [95% CI], -5.38 kg [-6.65, -4.11] kg), canagliflozin 300 mg (MD [95% CI], -2.31 kg [-2.79, -1.83] kg), and empagliflozin 10 mg (MD [95% CI], -2.00 kg [-2.44, -1.55] kg). In reducing systolic blood pressure (SBP), canagliflozin 300 mg showed the greatest effect (MD [95% CI], -5.96% [-7.96, -3.96] %). For diastolic blood pressure (DBP), henagliflozin 5 mg demonstrated the most significant reduction compared to placebo (MD [95% CI], -2.46% [-3.82, -1.10] %). Liraglutide 1.8 mg was most likely to cause adverse events (AE) (OR [95% CI], 2.57 [1.78, 3.70]), but there was no significant difference in serious adverse events (SAEs) between the interventions (including placebo).

CONCLUSION: Out of the seven medications examined in this study, tirzepatide demonstrates the most effective antidiabetic and weight-reducing effects. Furthermore, the dosage of Liraglutide at 1.2 mg and above demonstrates a more pronounced hypoglycemic effect in comparison to SGLT2 inhibitors. SGLT2 inhibitors exhibit a distinct hypotensive effect and are suitable for diabetic individuals experiencing hypertension.

Key numbers

-2.24%

Reduction

Mean difference compared to placebo for tirzepatide 15 mg.

-8.74 kg

Weight Loss

Mean difference compared to placebo for tirzepatide 15 mg.

-5.96%

Reduction

Mean difference compared to placebo for canagliflozin 300 mg.

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Abstract

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