Liraglutide Achieves A1C Targets More often than Sitagliptin or Exenatide when Added to Metformin in Patients with Type 2 Diabetes and a Baseline A1C <8.0% |
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| Institution: | 1. Diabetes Care Center, Salinas, California, United States;2. IDIBELL-Hospital Universitari Bellvitge, CIBERDEM, Barcelona, Spain;;3. Florida Hospital, Orlando, Florida, United States;4. Department of Endocrinology, Ochsner Medical Center, New Orleans, Louisiana, United States;5. Novo Nordisk A/S, Sϕborg, Denmark;;6. Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Italy.;1. Endocrinology Service, Experimental Endocrinology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social 11560 Mexico City, Mexico;;2. Departments of Medicine and Clinical Pathology, The American British Cowdray Medical Center.;1. Saint Luke''s Mid America Heart Institute and the;2. University of Missouri-Kansas City, Kansas City, Missouri;1. Section of Endocrinology and Metabolism, Department of Medicine, Jesse Brown VA and Section of Endocrinology and Metabolism, Department of Medicine, University of Illinois Medical Centers, Chicago, Illinois 60612.;1. Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, Rochester, Minnesota;2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota;3. Gold Cross Ambulance, Mayo Clinic, Rochester, Minnesota;4. Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota |
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| Abstract: | ObjectiveCompare the safety and efficacy of liraglutide to that of sitagliptin or exenatide as add-on to metformin in patients with type 2 diabetes (T2D) and glycated hemoglobin (A1C) <8.0%.MethodsPost hoc analysis of 26-week data from liraglutide 1.8 mg once daily (OD) versus exenatide 10 μg twice daily (LEAD-6) and liraglutide 1.8 mg OD versus sitagliptin 100 mg OD (LIRA-DPP-4); only patients treated as add-on to metformin with baseline A1C <8.0% were included. Efficacy analysis was performed on the intention-to-treat population with missing values imputed by last observation carried forward.ResultsMore patients achieved A1C targets (<7.0% and ≤6.5%) with liraglutide versus exenatide or sitagliptin; the difference was greatest for A1C ≤6.5% (LEAD-6: 65% versus 35%; odds ratio OR]=3.37, 95% confidence interval CI]: 1.31-8.63; P = .01 or LIRA-DPP-4: 53% versus 19%; OR = 4.78, 95% CI 2.10 to 10.87; P = .0002). Significantly more patients achieved a composite endpoint of A1C <7.0% with no weight gain or hypoglycemia with liraglutide compared with exenatide (78% versus 42%; OR = 4.99, 95% CI: 1.77 to 14.04; P = .0023) or sitagliptin (61% versus 21%; OR = 5.95, 95% CI: 2.66 to 13.29; P<.0001). All treatments were well tolerated, there was no major hypoglycemia and few patients (8 to 10%) experienced minor hypoglycemia.ConclusionWhen added to metformin in patients with an A1C <8.0%, more patients using liraglutide 1.8 mg reached A1C targets than with exenatide or sitagliptin. Sitagliptin had particularly low efficacy in this analysis. These data support the use of liraglutide 1.8 mg as a safe and effective alternative to sitagliptin or exenatide following metformin failure in patients with an A1C <8.0%. (Endocr Pract. 2013;19:64-72) |
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