Oxford Outcomes Ltd, Oxford, UK.
Diabetes Obes Metab. 2013 Mar;15(3):213-23. doi: 10.1111/dom.12007. Epub 2012 Oct 3.
The glucagon-like peptide-1 receptor agonists (GLP-1 RAs) exenatide once weekly (ExQW) and liraglutide once daily (QD) are indicated to improve glycaemic control in patients with type 2 diabetes. Although glycaemic control with ExQW versus liraglutide QD 1.8 mg has been directly compared, no studies have compared ExQW with liraglutide QD 1.2 mg or determined the probable relative efficacies of various injectable therapies for glycaemic control; therefore, a network meta-analysis was performed to address these questions.
A systematic review identified randomized controlled trials of ≥24 weeks that compared ExQW, liraglutide QD (1.2 mg, 1.8 mg), insulin glargine, exenatide twice daily (ExBID), or placebo. Twenty-two studies evaluating 11 049 patients were included in the network meta-analysis. Mean differences in HbA1c relative to placebo or each other and probability rankings were estimated.
Estimated mean differences in HbA1c versus placebo were -1.15% (95% CrI: -1.31 to -1.00) for ExQW, -1.01% (95% CrI: -1.18 to -0.85) for liraglutide 1.2 mg, and -1.18% (95% CrI: -1.32 to -1.04) for liraglutide 1.8 mg. HbA1c differences for ExQW versus liraglutide 1.2 mg and 1.8 mg were -0.14% (95% CrI: -0.34 to 0.06) and 0.03% (95% CrI: -0.14 to 0.18), respectively. The estimated mean difference in HbA1c between liraglutide 1.2 mg and 1.8 mg was 0.17% (95% CrI: 0.02-0.30). Results were consistent when adjusted for background antihyperglycaemic medications and diabetes duration.
This network meta-analysis did not identify meaningful differences in HbA1c lowering between ExQW and both liraglutide doses, suggesting that these GLP-1 RAs have similar glycaemic effects.
胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）艾塞那肽每周一次（ExQW）和利拉鲁肽每日一次（QD）被批准用于改善 2 型糖尿病患者的血糖控制。虽然已经直接比较了 ExQW 与利拉鲁肽 QD 1.8mg 的血糖控制，但尚无研究比较 ExQW 与利拉鲁肽 QD 1.2mg 或确定各种注射用疗法对血糖控制的可能相对疗效；因此，进行了一项网络荟萃分析来解决这些问题。
系统评价确定了≥24 周的随机对照试验，比较了 ExQW、利拉鲁肽 QD（1.2mg、1.8mg）、甘精胰岛素、艾塞那肽每日两次（ExBID）或安慰剂。网络荟萃分析共纳入了 22 项研究共 11049 名患者。估计了相对于安慰剂或彼此的 HbA1c 均值差异和概率排名。
ExQW 相对于安慰剂的 HbA1c 估计平均差异为-1.15%（95%置信区间：-1.31 至-1.00），利拉鲁肽 1.2mg 为-1.01%（95%置信区间：-1.18 至-0.85），利拉鲁肽 1.8mg 为-1.18%（95%置信区间：-1.32 至-1.04）。ExQW 与利拉鲁肽 1.2mg 和 1.8mg 的 HbA1c 差异分别为-0.14%（95%置信区间：-0.34 至 0.06）和 0.03%（95%置信区间：-0.14 至 0.18）。利拉鲁肽 1.2mg 和 1.8mg 之间 HbA1c 的估计平均差异为 0.17%（95%置信区间：0.02-0.30）。当调整背景抗高血糖药物和糖尿病持续时间后，结果仍然一致。
这项网络荟萃分析未发现 ExQW 和利拉鲁肽两种剂量在降低 HbA1c 方面有意义的差异，表明这些 GLP-1 RAs 具有相似的血糖作用。
