Health Human Resources Research Center, Department of Health Economics, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR, Iran.
Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR, Iran.
Daru. 2017 Oct 25;25(1):23. doi: 10.1186/s40199-017-0189-6.
Diabetes is one of the most common chronic and costly diseases worldwide and type 2 diabetes is the most common type which accounts for about 90% of cases with diabetes. New medication-therapy regimens such as those containing linagliptin alone or in combination with other medications (within the category of DDP-4 inhibitors) must be evaluated in terms of efficacy and compared with other currently used drugs and then enter the medication list of the country. Hence, this study aimed to compare the clinical efficacy of the two drugs, i.e. linagliptin and sitagliptin, in patients with type 2 diabetes.
A systematic review was conducted to identify all clinical trials published by 2015 which compared the two drugs in patients with type 2 diabetes. Using keywords such as "linagliptin", "type 2 diabetes mellitus", "sitagliptin" and related combinations, we searched databases including Scopus, PubMed, and Web of Science. The quality of the selected studies was evaluated using the Jadad score. Considering primary and secondary outcomes extracted from the reviewed studies, a network meta-analysis was used to conduct a systematic comparison between the two studied drugs.
This network meta-analysis included 32 studies (Linagliptin vs PLB: n = 8, Sitagliptin vs PLB: n = 13, Linagliptin + MET vs PLB + MET: n = 4, and Sitagliptin + MET vs PLB + MET: n = 7) and a total of 13,747 patients. The results showed no significant difference between linagliptin and sitagliptin in terms of key efficacy and safety outcomes such as HbA1c changes from baseline, body weight change from baseline, percentage of patients achieving HbA1c <7, and percentage of patients experiencing hypoglycemic events (p > 0.05). The results showed that the efficacy of the two drug regimens was the same.
Based on the results, there was no significant difference between the two drugs, i.e. linagliptin and sitagliptin, in terms of efficacy; in other words, the efficacy of the two drugs was the same. Therefore, the use of these two drugs depends on their availability and cost. Graphical abstract of the network meta-analysis performed to evaluate the alternatives under the study.
糖尿病是全球最常见的慢性和高花费疾病之一，其中 2 型糖尿病最为常见，占糖尿病病例的 90%左右。新型药物治疗方案，如单独使用利拉利汀或与其他药物联合使用（DPP-4 抑制剂类别内），必须根据疗效进行评估，并与其他当前使用的药物进行比较，然后才能进入国家药物清单。因此，本研究旨在比较两种药物，即利拉利汀和西他列汀，在 2 型糖尿病患者中的临床疗效。
系统检索了截至 2015 年发表的所有比较两种药物治疗 2 型糖尿病患者的临床试验。使用“利拉利汀”、“2 型糖尿病”、“西他列汀”等关键词，检索 Scopus、PubMed 和 Web of Science 等数据库。使用 Jadad 评分评估入选研究的质量。考虑从综述研究中提取的主要和次要结局，采用网络荟萃分析对两种研究药物进行系统比较。
本网络荟萃分析纳入了 32 项研究（利拉利汀 vs 安慰剂：n=8；西他列汀 vs 安慰剂：n=13；利拉利汀+MET vs 安慰剂+MET：n=4；西他列汀+MET vs 安慰剂+MET：n=7），共纳入 13747 例患者。结果显示，利拉利汀和西他列汀在关键疗效和安全性结局方面（从基线的 HbA1c 变化、从基线的体重变化、达到 HbA1c<7%的患者比例和发生低血糖事件的患者比例）无显著差异（p>0.05）。结果表明，两种药物方案的疗效相同。
基于这些结果，利拉利汀和西他列汀在疗效方面无显著差异；换句话说，两种药物的疗效相同。因此，这两种药物的使用取决于其可获得性和成本。研究中评估替代方案的网络荟萃分析示意图。
