An indirect treatment comparison of the efficacy of insulin degludec/liraglutide (IDegLira) and insulin glargine/lixisenatide (iGlarLixi) in patients with type 2 diabetes uncontrolled on basal insulin

Evans, Marc; Billings, Liana K.; Håkan‐Bloch, Jonas; Slothuus, Ulla; Abrahamsen, Trine Julie; Andersen, Andreas; Jansen, Jeroen P.

doi:10.1080/13696998.2017.1409228

Cited by 25 publications

(37 citation statements)

References 33 publications

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“…The present analysis assessed the cost-effectiveness of IDegLira versus iGlarLixi in the Czech Republic for patients with T2DM who were inadequately controlled on basal insulin. Based on clinical data from the DUAL II trial and an ITC comparing IDegLira with iGlarLixi, outcomes were projected over patient lifetimes using a validated health economic model [ 13 , 24 , 32 ]. At a WTP threshold of CZK 1,200,000 per QALY gained, IDegLira was found to be cost-effective versus both iGlarLixi pens currently available (containing 33 and 50 μg/mL of lixisenatide, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment effects for IDegLira were taken from the DUAL II trial (Table 2 ) [ 13 ]. Treatment effects for iGlarLixi were calculated by applying the between-treatment differences (in HbA1c, body weight and daily doses) and rate ratios (in hypoglycemic event rates) obtained from a previously published indirect treatment comparison (ITC) to the treatments effects for IDegLira [ 32 ]. For example, an HbA1c reduction of − 1.92% was applied for IDegLira based on results from DUAL II.…”

Section: Methodsmentioning

confidence: 99%

“…Pharmacy costs were calculated based on resource use data obtained from DUAL II data for IDegLira (45.0 dose-steps per day) [ 13 ]. The mean difference in end-of-trial daily insulin doses between IDegLira and iGlarLixi reported by the ITC was applied to the IDegLira dose to obtain the daily iGlarLixi dose (48.6 dose-steps per day) [ 32 ]. Daily basal and bolus insulin doses were assumed to be equal following intensification after 5 years of fixed-ratio combination treatment in both arms, and were based on the DUAL VII study [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

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Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Pöhlmann¹,

Russel-Szymczyk²,

Holik³

et al. 2019

Diabetes Ther

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Introduction Few patients with type 2 diabetes mellitus (T2DM) achieve recommended glycemic control targets in the Czech Republic. Novel therapies, such as fixed-ratio combinations of basal insulin plus glucagon-like peptide-1 receptor agonists, may contribute to better glycemic control. In the analysis presented here, the present analysis assessed the long-term cost-effectiveness of two fixed-ratio combinations, IDegLira (insulin degludec/liraglutide) and iGlarLixi (insulin glargine/lixisenatide), for the treatment of patients with T2DM inadequately controlled with basal insulin from a healthcare payer perspective in the Czech Republic. Methods A cost-effectiveness analysis was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Treatment effects were obtained from an indirect treatment comparison as no head-to-head data for IDegLira versus iGlarLixi are currently available. IDegLira was compared with two iGlarLixi pens (100 U/mL insulin glargine + 33 μg/mL and 50 μg/mL of lixisenatide, respectively). Direct medical costs associated with pharmaceutical interventions, screening and diabetes-related complications were captured. Deterministic and probabilistic sensitivity analyses were performed. Results IDegLira was associated with gains in life expectancy of 0.11 years and in quality-adjusted life expectancy of 0.14 quality-adjusted life-years (QALYs) versus iGlarLixi, due to a lower cumulative incidence and delayed onset of diabetes-related complications. IDegLira was also associated with higher projected costs due to higher acquisition costs; however, these were partially offset by cost savings from avoided complications. IDegLira was associated with incremental cost-effectiveness ratios of Czech Koruna (CZK) 695,998 and CZK 348,323 per QALY gained versus iGlarLixi pens containing 33 and 50 μg/mL of lixisenatide, respectively. These ratios were below the commonly used willingness-to-pay threshold of CZK 1,200,000 per QALY gained. Conclusion The present analysis indicated that IDegLira was associated with clinical benefits relative to iGlarLixi over patient lifetimes and was likely to be cost-effective in the treatment of patients with T2DM uncontrolled on basal insulin in the Czech Republic. Funding Novo Nordisk. Plain Language Summary Plain language summary is available for this article. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0569-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Pöhlmann¹,

Russel-Szymczyk²,

Holik³

et al. 2019

Diabetes Ther

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“…In studies comparing these fixed-dose combinations with the insulin component only, IdegLira seems to produce greater differences in HbA 1c (66,67) than IglarLixi (68,69), compatible with the differences in glycaemic efficacy displayed by the two GLP-1 receptor agonists on a background of oral glucoselowering agents (87). According to a meta-analysis, IdegLira is more potent in controlling glycaemia and body weight than iGlarLixi (104).…”

Section: Comparative Effectiveness Of Various Glp-1 Receptor Agonistsmentioning

confidence: 92%

MANAGEMENT OF ENDOCRINE DISEASE: Are all GLP-1 agonists equal in the treatment of type 2 diabetes?

Nauck

2019

European Journal of Endocrinology

186

193

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GLP-1, a peptide hormone secreted from the gut, stimulating insulin and suppressing glucagon secretion was identified as a parent compound for novel treatments of diabetes, but was degraded (dipeptidyl peptidase-4) and eliminated (mainly by kidneys) too fast (half-life 1–2 min) to be useful as a therapeutic agent. GLP-1 receptor agonist has been used to treat patients with type 2 diabetes since 2007, when exenatide (twice daily) was approved in 2007. Compounds with longer duration of action (once daily, once weekly) and with increasingly better efficacy with respect to glycaemic control and body weight reduction have been developed, and in a recent ADA/EASD consensus statement, were recommended as the first injectable diabetes therapy after failure of oral glucose-lowering medications. Most GLP-1 receptor agonists (lixisenatide q.d., liraglutide q.d., exenatide q.w., dulaglutide q.w., albiglutide q.w., semaglutide q.w., all for s.c. injection, and the first oral preparation, oral semaglutide) have been examined in cardiovascular outcomes studies. Beyond proving their safety in vulnerable patients, most of whom had pre-existing heart disease, liraglutide, semaglutide, albiglutide, and dulaglutide reduced the time to first major adverse cardiovascular events (non-fatal myocardial infarction and stroke, cardiovascular death). Liraglutide, in addition, reduced cardiovascular and all-cause mortality. It is the purpose of the present review to describe clinically important differences, regarding pharmacokinetic behaviour, glucose-lowering potency, effectiveness of reducing body weight and controlling other cardiovascular risk factors, and of the influence of GLP-1 receptor agonist treatment on cardiovascular outcomes in patients either presenting with or without pre-existing cardiovascular disease (atherosclerotic, ischemic or congestive heart failure).

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“…The fixed-ratio combinations have not yet been directly compared, although such studies would be of interest. Indirect comparisons are available [48,49], but, given their nature, caution is required when interpreting their findings (i.e. HbA 1c and bodyweight benefits are similar between the two combinations [48] or are more favourable with insulin degludec/liraglutide [49]).…”

Section: What Is the Current Clinical Position Of Insulin Glargine/limentioning

confidence: 99%

Insulin glargine/lixisenatide in type 2 diabetes: a profile of its use

Deeks

2019

Drugs Ther Perspect

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Subcutaneous insulin glargine/lixisenatide [Suliqua ® 100/33 and 100/50 (EU); Soliqua ® 100/33 (USA)] is a titratable, fixedratio combination of a long-acting basal insulin analogue + a glucagon-like peptide-1 receptor agonist (GLP-1 RA) approved to treat inadequately controlled type 2 diabetes (T2D) in adults. Once-daily insulin glargine/lixisenatide provided glycaemic control better than that of insulin glargine or lixisenatide in insulin-naive patients (when added to metformin) and better than that of insulin glargine in insulin-experienced patients (when used ± metformin) in phase 3 trials in adults with inadequately controlled T2D. It also had a beneficial effect on bodyweight and did not increase the frequency of hypoglycaemia versus insulin glargine. Insulin glargine/lixisenatide is generally well tolerated and offers the convenience of once-daily administration of two subcutaneous antihyperglycaemic agents. It is, therefore, a valuable option for improving glycaemic control in adults with T2D when this has not been provided by metformin alone or metformin + another oral antihyperglycaemic agent or + basal insulin. Adis evaluation of insulin glargine/lixisenatide in the treatment of T2DOnce-daily fixed-ratio combination of a long-acting insulin analogue (insulin glargine) + a GLP-1 RA (lixisenatide)Titratable to meet the insulin needs of the individual patient Provides better glycaemic control as an add-on to metformin than insulin glargine or lixisenatide in insulinnaive patients Provides better glycaemic control than insulin glargine, when used ± metformin, in insulin-experienced patients Does not increase hypoglycaemic risk vs insulin glargineSafety profile is generally consistent with its components Additional information for this Adis Drug Q&A can be found at https ://doi.org/10.6084/m9.figsh are.96963 38.

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An indirect treatment comparison of the efficacy of insulin degludec/liraglutide (IDegLira) and insulin glargine/lixisenatide (iGlarLixi) in patients with type 2 diabetes uncontrolled on basal insulin

Abstract: The results of this indirect treatment comparison demonstrate that, among patients with T2DM uncontrolled on basal insulin, treatment with IDegLira results in a greater reduction of HbA and a greater reduction in body weight compared with iGlarLixi at similar insulin doses.

Cited by 25 publications

References 33 publications

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

MANAGEMENT OF ENDOCRINE DISEASE: Are all GLP-1 agonists equal in the treatment of type 2 diabetes?

Insulin glargine/lixisenatide in type 2 diabetes: a profile of its use

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