Liraglutide achieves HbA<sub>1c</sub> targets more often than sitagliptin or exenatide when added to metformin in patients with type 2 diabetes and a baseline HbA<sub>1c</sub> <8.0% — ASN Events
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Liraglutide achieves HbA1c targets more often than sitagliptin or exenatide when added to metformin in patients with type 2 diabetes and a baseline HbA1c <8.0% (#259)

Stephen Colagiuri 1 , Allen B King 2 , Eduard Montanya 3 , Richard E Pratley 4 , Lawrence Blonde 5 , Claus Svendsen 6 , Morten Donsmark 6 , Giorgio Sesti 7
  1. University of Sydney, Sydney, NSW, Australia
  2. Diabetes Care Center, Salinas, CA, USA
  3. IDIBELL-Hospital Universitari Bellvitge, Barcelona, Spain
  4. Florida Hospital, Orlando, FL, USA
  5. Dept. Endocrinology, Ochsner Medical Center, New Orleans, LA, USA
  6. Novo Nordisk A/S, Søborg, Denmark
  7. Department of Clinical and Experimental Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy

Limited data are available to clinicians on efficacy of incretin therapies in T2D patients close to glycaemic target. This analysis compared the efficacy of liraglutide 1.8 mg once daily (OD) to exenatide 10 μg twice daily and sitagliptin 100 mg OD in patients with baseline HbA1c <8%.

This post-hoc analysis of 26-week data from the LEAD-6 and LIRA–DPP-4 studies only included T2D patients treated as true add-on to metformin (n=218). Patient baseline data were similar for all groups (mean HbA1c 7.3–7.6%), except mean disease duration in LEAD-6: exenatide vs. liraglutide (3.9 vs. 6.9 years). Change in HbA1c and body weight were analysed using ANCOVA based on intention to treat (ITT) population. Logistic regression analysis of ITT population compared the proportion of patients achieving glycaemic targets (≤6.5% and <7.0%). Post-baseline data were imputed at week 26 using last observation carried forward for missing observations.

In LEAD-6, a greater reduction of HbA1c was estimated in the liraglutide group vs. exenatide (−0.87% vs. −0.60%; estimated treatment difference (ETD) −0.27%; p=0.05). In LIRA–DPP-4, liraglutide treatment resulted in a significantly greater reduction in HbA1c vs. sitagliptin (−1.01% vs. −0.48%; ETD −0.53%, p<0.0001). In LEAD-6 and LIRA-DPP-4, liraglutide treatment resulted in a significantly higher proportion of patients achieving both glycemic targets (Figure). Mean weight loss with liraglutide was greater vs. exenatide (−3.68 kg vs. −2.62 kg; ETD −1.06 kg) but not significant, whereas it was significant vs. sitagliptin (−3.46 kg vs. −0.50 kg; ETD −2.96 kg; p<0.0001). Minor hypoglycaemia (self-treated, plasma glucose concentration <3.1 mmol/L) was low (8–10%) with all therapies.

In patients with baseline HbA1c <8%, liraglutide 1.8 mg brought significantly more patients to target, with greater weight loss than exenatide or sitagliptin. This should be considered by clinicians when choosing an add-on to metformin in patients already close to target.

Figure. Patients achieving glycaemic targets in the LEAD-6 and LIRA–DPP-4 studies.

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