Orally Administered Semaglutide Versus GLP-1 RAs in Patients with Type 2 Diabetes Previously Receiving 1-2 Oral Antidiabetics: Systematic Review and Network Meta-Analysis.

IF 2.8 3区医学 Q3 ENDOCRINOLOGY & METABOLISM Diabetes Therapy Pub Date : 2019-12-01 Epub Date: 2019-10-10 DOI:10.1007/s13300-019-00706-y

Solomon Nuhoho, Jatin Gupta, Brian Bekker Hansen, Mary Fletcher-Louis, Tam Dang-Tan, Abby Paine

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Abstract

Introduction: Orally administered semaglutide is the first glucagon-like peptide 1 receptor agonist (GLP-1 RA) for oral administration. As head-to-head trials assessing orally administered semaglutide as an add-on to 1-2 oral antidiabetic drugs (OADs) vs other GLP-1 RAs are limited, a network meta-analysis (NMA) was performed to assess the relative efficacy and safety of orally administered semaglutide 14 mg once-daily (QD) vs injectable GLP-1 RAs in patients with type 2 diabetes inadequately controlled on 1-2 OADs.

Methods: A systematic literature review was conducted to identify randomised controlled trials of GLP-1 RAs in patients inadequately controlled on 1-2 OADs. Data at 26 ± 4 weeks were extracted for efficacy and safety outcomes feasible for the NMA: change from baseline in glycated haemoglobin (HbA_1c), weight, HbA_1c target levels (< 7.0% and ≤ 6.5%), blood pressure, and any gastrointestinal adverse events specified in system organ class. Data were synthesised using NMA and a Bayesian framework.

Results: In total, 27 studies were included in the analyses. Orally administered semaglutide 14 mg QD was associated with significantly greater reductions in HbA_1c vs most comparators, and numerically greater reductions vs semaglutide 0.5 mg once-weekly (QW), dulaglutide 1.5 mg QW and liraglutide 1.8 mg QD. HbA_1c reductions with semaglutide 1 mg QW were numerically greater than those with orally administered semaglutide 14 mg QD. Reductions in body weight for orally administered semaglutide 14 mg QD were significantly greater than all comparators except semaglutide QW (both doses). Orally administered semaglutide QD 14 mg was associated with statistically similar odds of experiencing gastrointestinal adverse events vs injectable GLP-1 RAs.

Conclusion: Orally administered semaglutide 14 mg QD as an add-on to 1-2 OADs is one of the most efficacious GLP-1 RAs for reducing HbA_1c and body weight at 26 ± 4 weeks. Orally administered semaglutide 14 mg QD is well tolerated, with a safety profile in line with the GLP-1 RA class.

Funding: Novo Nordisk.

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曾接受1-2次口服抗糖尿病药物治疗的2型糖尿病患者口服Semagudie与GLP-1 RA的比较：系统综述和网络荟萃分析

简介口服塞马鲁肽是第一种用于口服的胰高血糖素样肽 1 受体激动剂（GLP-1 RA）。由于评估口服塞马鲁肽作为1-2种口服抗糖尿病药物（OADs）的附加药与其他GLP-1 RAs的头对头试验有限，因此我们进行了一项网络荟萃分析（NMA），以评估口服塞马鲁肽14毫克每日一次（QD）与注射用GLP-1 RAs在使用1-2种OADs控制不佳的2型糖尿病患者中的相对疗效和安全性：对文献进行系统回顾，以确定针对使用 1-2 种 OADs 控制不佳的患者的 GLP-1 RAs 随机对照试验。提取了 26 ± 4 周的数据，以获得对 NMA 可行的疗效和安全性结果：糖化血红蛋白 (HbA1c)、体重、HbA1c 目标水平（结果）与基线相比的变化：共有 27 项研究被纳入分析。与大多数比较药相比，口服塞马鲁肽 14 毫克 QD 的 HbA1c 降幅明显更大；与塞马鲁肽 0.5 毫克每周一次 (QW)、度拉鲁肽 1.5 毫克 QW 和利拉鲁肽 1.8 毫克 QD 相比，口服塞马鲁肽 14 毫克 QD 的 HbA1c 降幅更大。与口服塞马鲁肽 14 毫克 QD 相比，口服塞马鲁肽 1 毫克 QW 的 HbA1c 降低幅度更大。口服塞马鲁肽 14 毫克 QD 的体重降低幅度明显高于除塞马鲁肽 QW（两种剂量）以外的所有比较药。与注射用 GLP-1 RA 相比，口服塞马鲁肽 14 毫克 QD 发生胃肠道不良事件的几率在统计学上相似：结论：口服塞马鲁肽 14 毫克 QD 作为 1-2 种 OADs 的附加用药，是 26 ± 4 周内降低 HbA1c 和体重最有效的 GLP-1 RAs 之一。口服塞马鲁肽 14 毫克 QD 的耐受性良好，其安全性与 GLP-1 RA 类药物一致：资金来源：诺和诺德公司。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

自引率

7.90%

发文量

130

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.