Optimal use of once-weekly basal insulin efsitora alfa in type 1 and type 2 diabetes: A systematic review and meta-analysis.

Abstract

Objective: No meta-analysis has holistically analyzed and summarized the efficacy and safety of the novel once-weekly basal insulin efsitora alfa in managing type 1 diabetes (T1D) and type 2 diabetes (T2D).

Methods: Clinical trials involving subjects with T1D and T2D receiving once-weekly efsitora alfa in the intervention arm and once-daily basal insulins in the control arm were searched throughout the electronic databases. The primary outcome assessed was the change from baseline in HbA1c.

Results: Data from 6 studies (2,465 subjects) were analyzed (follow-up 26-54 weeks). Once-weekly efsitora alfa and once-daily degludec achieved comparable HbA1c reduction in study subjects with T2D (mean difference [MD] 0.02% [-0.11, 0.16]; P = 0.74) and T1D (MD 0.11% [-0.01, 0.22]; P = 0.08). Efsitora and degludec were similarly effective in reducing fasting plasma glucose and achieving HbA1c <7% in subjects with T2D. Individuals with T2D and T1D in the two groups had comparable time in range, time above range, and time below range. Subjects with T2D receiving efsitora and once-daily basal insulin had comparable total adverse events (TAEs), severe adverse events (SAEs), injection-site reactions, hypersensitivity events, and overall and severe hypoglycemia; however, nocturnal hypoglycemia risk was lower with efsitora (risk ratio 0.85 [0.74, 0.98]; P = 0.03). However, in individuals with T1D, TAEs, SAEs, and injection-site reactions were higher with efsitora, with comparable risks of hypersensitivity events and overall, severe and nocturnal hypoglycemia.

Conclusion: Once-weekly basal insulin efsitora alfa is well tolerated with glycaemic efficacy similar to once-daily degludec.