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2014 ; 5
(1
): 1-41
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gab.com Text
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English Wikipedia
Comparative effectiveness of dipeptidylpeptidase-4 inhibitors in type 2 diabetes:
a systematic review and mixed treatment comparison
#MMPMID24664619
Craddy P
; Palin HJ
; Johnson KI
Diabetes Ther
2014[Jun]; 5
(1
): 1-41
PMID24664619
show ga
OBJECTIVE: To compare the safety and efficacy of the dipeptidylpeptidase-4
(DPP-4) inhibitors in patients with type 2 diabetes and inadequate glycemic
control. DESIGN: Systematic review of randomized controlled trials (RCTs), health
economic evaluation studies, systematic reviews, and meta-analyses, followed by
primary Bayesian mixed treatment comparison meta-analyses (MTCs), and secondary
frequentist direct-comparison meta-analyses using a random-effects model.
Outcomes were reported as weighted mean change from baseline, or odds ratio (OR)
with 95% credible interval. DATA SOURCES: MEDLINE, MEDLINE In-Process, EMBASE,
and BIOSIS via Dialog ProQuest; Cochrane Central Register of Controlled Trials
and Cochrane Database of Systematic Reviews via EBSCO; four diabetes and two
technical congress abstracts; and health technology assessment organization
websites. ELIGIBILITY CRITERIA: Patients with type 2 diabetes and inadequate
glycemic control receiving any pharmacological anti-diabetic treatment. DATA
EXTRACTION AND ANALYSIS: Title/abstracts were reviewed for eligibility, followed
by full-text review of publications remaining after first pass. A three-person
team filtered articles and an independent reviewer checked a random selection
(10%) of filtered articles. Data extraction and quality assessment of studies
were also independently reviewed. Five DPP-4 inhibitors (alogliptin, linagliptin,
saxagliptin, sitagliptin, and vildagliptin) were compared via meta-analysis
(where data were available) as monotherapy, dual therapy (plus metformin,
sulfonylurea, pioglitazone, or insulin), and triple therapy (plus
metformin/sulfonylurea). RESULTS: The review identified 6,601 articles; 163 met
inclusion criteria and 85 publications from 83 RCTs contained sufficient or
appropriate data for analysis. MTCs demonstrated no differences between DPP-4
inhibitors in mean change from baseline in glycosylated hemoglobin (HbA1c) or
body weight, or the proportions of patients achieving HbA1c <7% or experiencing a
hypoglycemic event, apart from in patients on alogliptin plus metformin, who
achieved HbA1c <7% more frequently than those treated with saxagliptin plus
metformin [OR 6.41 (95% CI 3.15-11.98) versus 2.17 (95% CI 1.56-2.95)].
CONCLUSIONS: This systematic review and MTC showed similar efficacy and safety
for DPP-4 inhibitors as treatment for type 2 diabetes, either as monotherapy or
combination therapy.