AIMS:To determine the comparative efficacy and safety of liraglutide and dipeptidyl peptidase-4 (DPP-4) inhibitors as antidiabetics for Japanese patients with uncontrolled type 2 diabetes (T2DM). METHODS AND MATERIALS:We searched for randomized controlled trials (RCTs) evaluating outcomes among Japanese adults with uncontrolled T2DM and including liraglutide or DPP-4 inhibitors up to August 2016. We extracted data on trial and patient characteristics, and the following outcomes: HbA1c, weight, patients meeting HbA1c <7%, patients experiencing hypoglycemic events, microalbuminuria, estimated glomerular filtration rate (eGFR) and creatinine. We synthesized data using network meta-analyses (NMA) using a Bayesian framework. Continuous outcomes were modeled using normal likelihoods and an identity link, while dichotomous outcomes were modeled using a binomial likelihood and a logit link. RESULTS:The systematic literature review yielded 39 publications pertaining to 38 trials. A total of 27 trials (5032 patients) reported change in HbA1c at 12 weeks and at 24 weeks 9 trials (2091 patients). All treatments showed statistically significant reductions in HbA1c relative to placebo at 12 and 24 weeks. Liraglutide 0.9 mg was statistically superior to all DPP-4 interventions (vildagliptin, sitagliptin, linagliptin, alogliptin, teneligliptin, trelagliptin and omarigliptin) at 12 weeks and 24 weeks among those reporting. Treatments were not statistically differentiable with respect to weight change and risk of hypoglycemia. Finally, no comparisons of eGFR and microalbuminuria were conducted, as this data was reported in too few trials to conduct analyses. LIMITATIONS:Some important outcomes were limited by poor reporting (eGFR and microalbuminuria) or low event rates (hypoglycemia). The follow-up time was relatively short. Clinically, the 24 week time point is more important as it demonstrates more sustained results. CONCLUSIONS:Our research suggests that liraglutide 0.9 mg offers a more efficacious treatment option for T2DM than the DPP-4 inhibitors among adult Japanese patients and that it is a viable option for this population.

译文

目的:确定利拉鲁肽和二肽基肽酶-4(DPP-4)抑制剂作为抗糖尿病药物对日本2型糖尿病(T2DM)患者的比较疗效和安全性。
方法和材料:我们搜寻了截至2016年8月截止的未控制T2DM并包括利拉鲁肽或DPP-4抑制剂的日本成年人的结局评估的随机对照试验(RCT)。我们提取了有关试验和患者特征的数据,以及以下结果:HbA1c,体重,满足HbA1c <7%的患者,发生降血糖事件,微量白蛋白尿,估计的肾小球滤过率(eGFR)和肌酐的患者。我们使用贝叶斯框架,使用网络荟萃分析(NMA)对数据进行了合成。使用正常可能性和同一性联系对连续结果进行建模,而使用二项式可能性和对数联系对二分结果进行建模。
结果:系统的文献综述产生了涉及38个试验的39种出版物。共有27项试验(5032例患者)报告了12周和24周时HbA1c的变化9项试验(2091例患者)。在12周和24周时,所有治疗均显示HbA1c相对于安慰剂有统计学意义的降低。在报告的第12周和第24周,0.9 mg利拉鲁肽优于所有DPP-4干预措施(维格列汀,西他列汀,利那列汀,阿格列汀,替利格列汀,海拉格列汀和奥格列汀)。就体重变化和低血糖风险而言,治疗无统计学差异。最后,没有进行eGFR和微量白蛋白尿的比较,因为该数据报道的试验太少而无法进行分析。
局限性:一些重要的结果受限于报告不佳(eGFR和微量白蛋白尿)或事件发生率低(低血糖)。随访时间相对较短。临床上,24周时间点更为重要,因为它显示了更持久的结果。
结论:我们的研究表明,在日本成年患者中,比起DPP-4抑制剂,0.9mg利拉鲁肽为T2DM提供了更有效的治疗选择,并且对于这一人群是可行的选择。

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