Liraglutide add-on may offer better control than OADs in type 2 diabetes
medwireNews: The addition of liraglutide rather than extra oral antidiabetic drugs (OADs) may offer more sustained glycemic control for people with type 2 diabetes who have inadequate control with metformin, suggest findings of the international LIRA-PRIME study.
Jeff Unger (Catalina Research Institute, Montclair, California, USA) and colleagues say their results support “liraglutide use when intensifying therapy in primary care patients with [type 2 diabetes].”
For LIRA-PRIME, the researchers randomly assigned individuals with type 2 diabetes and a glycated hemoglobin (HbA1c) level of 7.5% to 9.0% (58–75 mmol/mol) while on metformin to receive up to 104 weeks of treatment with either liraglutide (escalated from 0.6 to 1.8 mg/day; n=996) or an investigator-selected OAD (n=995).
The most commonly chosen OADs were sodium-glucose cotransporter (SGLT)2 inhibitors (47.9%), followed by dipeptidyl peptidase (DPP)-4 inhibitors (39.7%), sulfonylureas (10.8%), thiazolidinediones (1.1%), and α-glucosidase inhibitors (0.5%). Individuals in both groups continued with metformin at their pre-trial dose throughout the study.
As reported in Diabetes, Obesity & Metabolism, people in the liraglutide group spent significantly more time with adequately controlled diabetes than those in the OAD group.
Specifically, the median time to inadequate glycemic control, defined as HbA1c above 7.0% (53 mmol/mol) at two consecutive visits after week 26, was a significant 44 weeks longer with liraglutide than with OADs, at 109 versus 65 weeks.
In addition, the median time to premature treatment discontinuation for any reason was a significant 28 weeks longer with liraglutide than with OADs, at 80 versus 52 weeks.
Post-hoc analyses comparing liraglutide with SGLT2 inhibitors, DPP-4 inhibitors, and sulfonylureas separately showed similar outcomes.
Unger and team also found that, at week 104, liraglutide-treated participants had significantly greater reductions in HbA1c, fasting plasma glucose, body weight, and BMI than those who were treated with OADs.
Furthermore, the liraglutide group was a significant 1.88 times more likely to achieve an HbA1c level at or below 6.5% (47.5 mmol/mol) than the OAD group (31.6 vs 16.8%) and was more likely to achieve an HbA1c at or below 7.0% without weight gain (47.4 vs 28.0%) or severe or blood glucose-confirmed symptomatic hypoglycemia (61.2 vs 37.5%).
The overall rates of hypoglycemia were below 250 events per 1000 patient–years of exposure (PYE) in both groups, with severe or confirmed hypoglycemia incidence at 17.7 and 35.0 events per 1000 PYE with liraglutide and OADs, respectively. The corresponding serious adverse event rates were 9.4% and 8.2%.
Unger et al conclude: “This information may help guide decisions around intensifying therapy when metformin is insufficient in patients with [type 2 diabetes], particularly within the primary care setting.”
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