Glucagon-like peptide-1 receptor agonists: a systematic review of comparative effectiveness research

Levin, Philip; Nguyen, Hannah; Wittbrodt, Eric; Kim, Seo Young

doi:10.2147/dmso.s130834

Cited by 93 publications

(90 citation statements)

References 78 publications

(195 reference statements)

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“…Our analyses, however, are the most updated and robust including 13 RCTs with total of 4330 participants evaluated. Notably, other systematic reviews and meta‐analyses have compared GLP‐1 agonists with DPP‐4 inhibitors but their reports do not undercut the novelty of our current meta‐analyses . Specifically, Levin et al reported a systematic review of studies comparing GLP‐1 agonists with DPP‐4 inhibitor but did not include meta‐analyses of these data.…”

Section: Resultsmentioning

confidence: 95%

“…Notably, other systematic reviews and meta-analyses have compared GLP-1 agonists with DPP-4 inhibitors but their reports do not undercut the novelty of our current meta-analyses 31,32. Specifically, Levin et al31 reported a systematic review of studies comparing GLP-1 agonists with DPP-4 inhibitor but did not include meta-analyses of these data. Moreover, in the study of Pinelli et al, 32 the research question differed from our analyses insofar as only long-acting GLP-1's agonists were compared to DPP-4 inhibitors.…”

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confidence: 92%

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Efficacy of glucagon‐like peptide‐1 receptor agonists compared to dipeptidyl peptidase‐4 inhibitors for the management of type 2 diabetes: A meta‐analysis of randomized clinical trials

Tran

Retnakaran

Zinman

et al. 2018

Diabetes Obesity Metabolism

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Aims: Glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are both incretin-based therapies for type 2 diabetes (T2DM) but have distinct efficacy and side effect profiles. We thus performed a systematic review and meta-analysis to compare the effects of GLP-1 agonists to DPP-4 inhibitors on glycaemic control, weight and incidence of adverse events in adults with T2DM. We also sought to determine whether there was any additional effect in switching from DPP-4 inhibitor to GLP-1 agonist. Materials and methods:We systematically searched PubMed, Embase and ClinicalTrials.gov for (1) randomized controlled trials (RCTs) comparing any GLP-1 agonist to any DPP-4 inhibitor and (2) interventional studies where a DPP-4 inhibitor was switched to a GLP-1 agonist. We assessed pooled data using random-effects model (CRD42017057115). Results:The pooled analysis of 13 RCTs (n = 4330) showed that, compared to DPP-4 inhibitors, GLP-1 agonists yielded a greater mean reduction in glycated haemoglobin (HbA1c) of 2-7Although GLP-1 agonists and DPP-4 inhibitors exert their metabolic effects through the same entero-endocrine axis, they modulate diverse targets within the incretin system, resulting in distinct efficacy and side effect profiles. 8 In this context, there has been growing interest in comparing these 2 classes of anti-diabetic medications as reflected by a series of recent clinical trials [9][10][11] ; the data from these individual studies, however, might not be sufficient to provide robust estimates to guide the optimal choice between these agents. As such, ). All potentially eligible studies were considered for review, regardless of the primary outcome or language. A manual search was also performed, using references of key articles published in English.For the meta-analysis of RCTs comparing GLP-1 agonist to DPP-4 inhibitors, studies were considered eligible for inclusion if they:(1) were RCTs conducted in adults with T2DM, (2) compared any GLP-1 agonist to any DPP-4 inhibitor, (3) had at least 12 weeks duration of intervention, and (4) reported changes in HbA1c, changes in weight and the number of participants with any adverse events in each study arm. Exclusion criteria were as follows: (1) observational and retrospective studies, (2) studies with less than 12 weeks duration of intervention, and (3) studies that randomized patients to other therapies in addition to a GLP-1 agonist or DPP-4 inhibitor. If the result of a RCT was reported in more than one publication, we have included the data reporting the primary outcome and/or the data with duration of follow up closer to the average duration of follow up of the included studies. In addition, when studies reported more than one intervention arm using different doses of GLP-1 agonists, data from the maximum dosage was extracted as commonly used in clinical practice.For the meta-analyses of interventional switching studies, we included studies that were conducted in adults with T2DM and reported changes in HbA1c or weight before and af...

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Section: Resultsmentioning

confidence: 95%

mentioning

confidence: 92%

Efficacy of glucagon‐like peptide‐1 receptor agonists compared to dipeptidyl peptidase‐4 inhibitors for the management of type 2 diabetes: A meta‐analysis of randomized clinical trials

Tran

Retnakaran

Zinman

et al. 2018

Diabetes Obesity Metabolism

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“…Certainly, relative to sulfonylurea (SU) or insulin, the lower risk of hypoglycaemia with AHA is clear and widely accepted . However, relative to placebo, efficacy‐focused studies have been unable to delineate hypoglycaemia risk with these newer AHA, mainly due to the use of background SU and insulin.…”

Section: Introductionmentioning

confidence: 99%

Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis

Kamalinia

Josse

Donio

et al. 2019

Endocrino Diabet & Metabol

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Objectives: For patients with type 2 diabetes, newer antihyperglycaemic agents (AHA), including the dipeptidyl peptidase IV inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium glucose co-transporter 2 inhibitors (SGLT2i) offer a lower risk of hypoglycaemia relative to sulfonylurea or insulin.However, it is not clear how AHA compare to placebo on risk of any hypoglycaemia.This study evaluates the risk of any and severe hypoglycaemia with AHA and metformin relative to placebo. Design: A systematic review and meta-analysis was conducted of randomized, placebo-controlled trials ≥12 weeks in duration. MEDLINE, Embase and the Cochrane Library were searched up to April 16, 2019. Studies allowing use of other diabetes medications were excluded. Mantel-Haenszel risk ratio with 95% confidence intervals were used to pool estimates based on class of AHA and number of concomitant therapies used.Patients: Eligible studies enrolled patients with type 2 diabetes ≥18 years of age.Results: 144 studies met our inclusion criteria. Any hypoglycaemia was not increased with AHA when used as monotherapy (DPP4i (RR 1.12; 95% CI 0.81-1.56), GLP1RA (1.77; 0.91-3.46), SGLT2i (1.34; 0.83-2.15)), or as add-on to metformin (DPP4i (0.95; 0.67-1.35), GLP1RA (1.24; 0.80-1.91), SGLT2i (1.29; 0.91-1.83)) or as triple therapy (1.13; 0.67-1.91). However, metformin monotherapy (1.73; 1.02-2.94) and dual therapy initiation (3.56; 1.79-7.10) was associated with an increased risk of any hypoglycaemia. Severe hypoglycaemia was rare not increased for any comparisons. Conclusions:Metformin and the simultaneous initiation of dual therapy, but not AHA used alone or as single add-on combination therapy, was associated with an increased risk of any hypoglycaemia relative to placebo. K E Y W O R D S diabetes mellitus, type 2, dipeptidyl peptidase IV inhibitor, glucagon-like peptide-1 receptor agonist, hypoglycaemia, sodium glucose co-transporter 2 inhibitor S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Kamalinia S, Josse RG, Donio PJ, Leduc L, Shah BR, Tobe SW. Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta-analysis. Endocrinol Diab Metab. 2020;3:e00100. https ://doi.

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“…Safety of different antihyperglycaemic agents at different stages of eGFR receptor agonists then, work by the stimulation of GLP-1 receptors, enhancing insulin secretion, appetite suppression, delaying gastric emptying, and inhibiting glucagon release from the pancreas 55. Current clinically used GLP-1 RAs are resistant to Dipeptidyl Peptidase 4 (DPP4) cleavage and are generally long-acting drugs, reducing HbA1C with a variability between 1.3% and 1.9% 56. GLP-1-RAs use has increased in the past decade due to their efficacy and mostly due the low risk for hypoglycaemia and their beneficial effect on weight loss 57.…”

mentioning

confidence: 99%

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

Niezen

Castillo

Castaner

et al. 2019

Endocrino Diabet & Metabol

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Diabetic kidney disease (DKD) is the major contributor to the mortality and the financial burden of diabetes, accounting for approximately 50% of the cases of end‐stage renal disease (ESRD) in the developed world. Several studies have already demonstrated that achieving blood pressure targets in DKD with agents blocking the renin‐angiotensin system confer superior renoprotection when compared to other agents. However, the effects on renal outcomes of antihyperglycaemic agents in these patients have not been reported or studied broadly until recent years. The intent of this article is to review the available data on safety, efficacy, impact on renal outcomes and pathophysiology implications of the most utilized antihyperglycaemic agents in DKD/ESRD.

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Glucagon-like peptide-1 receptor agonists: a systematic review of comparative effectiveness research

Cited by 93 publications

References 78 publications

Efficacy of glucagon‐like peptide‐1 receptor agonists compared to dipeptidyl peptidase‐4 inhibitors for the management of type 2 diabetes: A meta‐analysis of randomized clinical trials

Efficacy of glucagon‐like peptide‐1 receptor agonists compared to dipeptidyl peptidase‐4 inhibitors for the management of type 2 diabetes: A meta‐analysis of randomized clinical trials

Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta‐analysis

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

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