Effectiveness of dulaglutide vs liraglutide and exenatide once-weekly. A real-world study and meta-analysis of observational studies.

Abstract

INTRODUCTION AND AIM:

Real-word data on the head-to-head comparisons among glucagon-like peptide-1 receptor agonists (GLP-1RA) are scant. Therefore, we aimed to compare the effectiveness of dulaglutide versus liraglutide and exenatide once weekly (exeOW) in type 2 diabetic (T2D) patients under routine care.

METHODS:

This was a retrospective, multicenter, real-world study on patients with T2D (aged 18-80) initiating a GLP-1RA between 2010 and 2018 at specialist outpatient clinics. We compared the effectiveness of dulaglutide versus liraglutide and exeOW on the changes in HbA1c (primary outcome), body weight, blood pressure and fasting glucose (secondary outcomes). Average follow-up was 5.9 months. Channelling biases were addressed with propensity score matching or multivariable adjustment. Meta-analyses of observational studies, covering the same comparisons, are also presented.

RESULTS:

849, 1371 and 198 patients were included in the dulaglutide, liraglutide and exeOW groups, respectively. The reduction of HbA1c was greater with dulaglutide than with liraglutide (-0.24 ± 0.08%; p = 0.003), and was confirmed in the meta-analysis of observational studies. In our study, dulaglutide showed similar effectiveness compared to exeOW. When these results were pooled with other observational studies, dulaglutide showed a greater reduction of HbA1c (-0.19%; p = 0.003) and body weight (-0.8 kg; p = 0.007).

CONCLUSIONS:

In a real-world scenario, dulaglutide reduced HbA1c more than liraglutide. Conversely, we found similar effect of dulaglutide and exeOW, with statistical differences arising solely when results were meta-analysed with those from other observational studies. Lack of up-titration for liraglutide and higher discontinuation rate for exeOW likely influenced the estimated treatment difference.

• Authors: Mario Luca Morieri, Mauro Rigato, Vera Frison, Natalino Simioni, Michele D'Ambrosio, Federica Tadiotto, Agostino Paccagnella, Annunziata Lapolla, Angelo Avogaro, Gian Paolo Fadini
• Journal: Metabolism: clinical and experimental (Metabolism) Vol. 106 Pg. 154190 (05 2020) ISSN: 1532-8600 [Electronic] United States
• PMID: 32109448 (Publication Type: Journal Article, Meta-Analysis, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• dulaglutide
• Exenatide
• Glucagon-Like Peptides
• Immunoglobulin Fc Fragments
• Liraglutide
• Recombinant Fusion Proteins

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Young Adult
• Diabetes Mellitus, Type 2 (blood, drug therapy, epidemiology)
• Drug Administration Schedule
• Drug Therapy, Combination
• Exenatide (administration & dosage, adverse effects)
• Follow-Up Studies
• Glucagon-Like Peptides (administration & dosage, adverse effects, analogs & derivatives)
• Immunoglobulin Fc Fragments (administration & dosage, adverse effects)
• Liraglutide (administration & dosage, adverse effects)
• Observational Studies as Topic (statistics & numerical data)
• Recombinant Fusion Proteins (administration & dosage, adverse effects)
• Retrospective Studies
• Treatment Outcome