Switching to the glucagon-like peptide-1 receptor agonist liraglutide from sitagliptin, a DPP-IV inhibitor, may be an effective strategy for controlling HbA1c, body weight, systolic blood pressure and hypoglycemic episodes in adults with type 2 diabetes uncontrolled with sitagliptin, according to findings presented at the 52nd European Association for the Study of Diabetes Annual Meeting.
“The idea of composite outcomes may be a little bit novel to the regulatory bodies, but to our patients it’s very intuitive that patients not only want to get to goal, but they want to get there safely with the least amount of hypoglycemia and preferably no weight gain,” Timothy Bailey, MD, FACE, FACP, director of the AMCR Institute in Escondido, California, said during his presentation.
Bailey and colleagues evaluated data on 406 adults (mean age, 56 years; 60% men) with type 2 diabetes treated with sitagliptin (Januvia, Merck) 100 mg per day plus metformin for at least 90 days randomly assigned to switch to liraglutide (Victoza, Novo Nordisk) 1.8 mg (n = 202) or to continue with sitagliptin (n = 204) once per day with metformin to determine the effects of each on glycemic, body weight, systolic BP and hypoglycemia outcomes after 26 weeks.
The composite endpoints included HbA1c less than 7% without weight gain; HbA1c less than 7% without weight gain and systolic BP less than 140 mm Hg; HbA1c reduction of at least 1% without weight gain; and HbA1c less than 7% without weight gain and without confirmed hypoglycemic episodes.
Composite endpoints were met by more participants assigned to liraglutide than those assigned to sitagliptin: HbA1c less than 7% without weight gain (OR = 3.4; 95% CI, 2.11-5.49), HbA1c less than 7% without weight gain and systolic BP less than 140 mm Hg (OR = 3.88; 95% CI, 2.36-6.39), HbA1c reduction of at least 1% without weight gain (OR = 2.85; 95% CI, 1.82-4.47) and HbA1c less than 7% without weight gain and without confirmed hypoglycemia episodes (OR = 3.4; 95% CI, 2.11-5.49).
“After 26 weeks, switching from sitagliptin 100 mg per day to liraglutide 1.8 mg per day, compared with continuing sitagliptin, on a background with metformin resulted in statistically significant improved glycemic control, including superior HbA1c reduction, superior reduction in body weight, more subjects reaching glycemic targets, and more subjects meeting clinically relevant composite endpoints relating to glycemia, body weight, systolic BP and hypoglycemia,” Bailey said. “When sitagliptin is insufficient to control glycemia, an approach that you switch to liraglutide provides a clinically relevant treatment option while still allowing subjects to remain on dual therapy.” – by Amber Cox
Bailey T, et al. OP 01. Presented at: 52nd EASD Annual Meeting; Sept. 12-16, 2016; Munich.
Disclosure: Bailey reports various financial ties with Abbott, ACON, AstraZeneca, Bayer, Becton Dickinson, Bristol-Myers Squibb, Dexcom, Eli Lilly and Co., GlaxoSmithKline, Insulet, Hanssen, Lexicon, Lifescan, Medtronic, Novo Nordisk and Sanofi.