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Comparative Effectiveness of Adding Alogliptin to Metformin Plus Sulfonylurea
with Other DPP-4 Inhibitors in Type 2 Diabetes: A Systematic Review and Network
Meta-Analysis
#MMPMID28275958
Kay S
; Strickson A
; Puelles J
; Selby R
; Benson E
; Tolley K
Diabetes Ther
2017[Apr]; 8
(2
): 251-273
PMID28275958
show ga
INTRODUCTION: Alogliptin is an oral antihyperglycemic agent that is a selective
inhibitor of the enzyme dipeptidyl peptidase-4 (DPP-4), approved for the
treatment of type 2 diabetes mellitus (T2DM). There currently exists no
comparative data to support the use of alogliptin in combination with metformin
(met) and sulfonylurea (SU). A decision-focused network meta-analysis (NMA) was
performed to compare the relative efficacy and safety of alogliptin 25 mg once
daily to other DPP-4 inhibitors as part of a triple therapy regimen for patients
inadequately controlled on metformin and SU dual therapy. METHODS: A systematic
literature review was conducted to identify published papers of randomized
controlled trials (RCTs) that compared alogliptin with other DPP-4 inhibitors
(linagliptin, saxagliptin, sitagliptin, and vildagliptin) at their Summary of
Product Characteristics (SmPC) recommended daily doses, added on to metformin and
SU. Comprehensive comparative analysis involving frequentist meta-analysis and
Bayesian NMA compared alogliptin to each DPP-4 inhibitor separately and
collectively as a group. Quasi-random effect models were introduced when random
effect models could not be estimated. RESULTS: The review identified 2186
articles, and 94 full-text articles were assessed for eligibility. Eight RCTs
contained appropriate data for inclusion in the NMA. All analyses over all trial
population sets produced very similar results, and show that alogliptin 25 mg is
as least as effective (as measured by change in HbA1c from baseline, but
supported by other outcome measures: change in body weight and FPG from baseline)
and safe (as measured by incidence of hypoglycemia and adverse events leading to
study discontinuation) as all the other DPP-4 inhibitors in triple therapy.
CONCLUSION: This decision-focused systematic review and NMA demonstrated
alogliptin 25 mg daily to have similar efficacy and safety compared to other
DPP-4 inhibitors, for the treatment of T2DM in adults inadequately controlled on
metformin and SU. (Funded by Takeda Development Centre Americas; EXAMINE
ClinicalTrials.gov number, NCT00968708).
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