Efficacy and Safety of Tirzepatide Compared with GLP-1 RAs in Patients with Type 2 Diabetes Treated with Basal Insulin: A Network Meta-analysis.

IF 3.8 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2025-06-01 Epub Date: 2025-04-11 DOI:10.1007/s13300-025-01728-5

Beatrice Osumili, Hélène Sapin, Zhengyu Yang, Kari Ranta, Jim S Paik, Matthias Blüher

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Abstract

Introduction: The relative efficacy and safety of tirzepatide was compared with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes mellitus (T2DM) treated with basal insulin using a network meta-analysis (NMA).

Methods: A systematic literature review was performed to identify randomized controlled trials of GLP-1 RAs in patients with T2DM treated with insulin and an antihyperglycaemic drug. For the NMA, studies included trials with 100% of patients treated with basal insulin background therapy with a titration scheme comparable to the SURPASS-5 trial. The following data were extracted for efficacy and safety assessment at the primary endpoint of each study: changes from baseline in glycated haemoglobin (HbA1c) and body weight and the incidence of nausea, vomiting or diarrhoea, hypoglycaemia, and patients discontinuing treatment because of adverse events. In this study, a comparative analysis of tirzepatide was performed with the GLP-1 RAs dulaglutide, exenatide, and lixisenatide in addition to placebo.

Results: A total of six studies were included across the analyses. Tirzepatide 5, 10, and 15 mg showed statistically significant, greater reductions in HbA1c and body weight at the primary endpoint versus all GLP-1 RA comparators and placebo. Tirzepatide 5, 10, and 15 mg showed a statistically significant, higher likelihood of experiencing nausea compared with those who received placebo or exenatide 2 mg; no statistically significant differences were observed when compared with all other GLP-1 RA comparators. No statistically significant differences were observed in the proportions of patients who discontinued treatment because of adverse events when tirzepatide 5, 10, and 15 mg were compared with GLP-1 RA comparators, apart from tirzepatide 10 and 15 mg versus placebo.

Conclusion: Tirzepatide demonstrated statistically significantly greater reductions in HbA1c and body weight when compared with selected GLP-1 RAs and placebo in patients with T2DM treated with basal insulin. Overall, the safety profile of tirzepatide was similar to that of GLP-1RAs.

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替西帕肽与GLP-1 RAs在基础胰岛素治疗2型糖尿病患者中的疗效和安全性：一项网络荟萃分析

采用网络meta分析（NMA）比较了替西帕肽与胰高血糖素样肽1受体激动剂（GLP-1 RAs）在基础胰岛素治疗2型糖尿病（T2DM）患者中的相对疗效和安全性。方法：通过系统的文献综述，确定GLP-1 RAs在胰岛素和抗高血糖药物治疗的T2DM患者中的随机对照试验。对于NMA，研究包括100%接受基础胰岛素背景治疗的患者的试验，其滴定方案与SURPASS-5试验相当。在每项研究的主要终点提取以下数据用于疗效和安全性评估：糖化血红蛋白（HbA1c）和体重与基线相比的变化，恶心、呕吐或腹泻、低血糖的发生率，以及因不良事件而停止治疗的患者。在本研究中，除了安慰剂外，还将替西帕肽与GLP-1 RAs dulaglutide、艾塞那肽和利昔那肽进行了比较分析。结果：整个分析共纳入了6项研究。与所有GLP-1 RA比较剂和安慰剂相比，替西帕肽5、10和15mg在主要终点的HbA1c和体重降低具有统计学意义。替西帕肽5mg、10mg和15mg具有统计学意义，与服用安慰剂或艾塞那肽2mg的患者相比，出现恶心的可能性更高；与其他GLP-1 RA比较物比较，差异无统计学意义。当替西帕肽5、10和15mg与GLP-1 RA比较时，由于不良事件而停止治疗的患者比例没有统计学上的显著差异，除了替西帕肽10和15mg与安慰剂相比。结论：在接受基础胰岛素治疗的T2DM患者中，与选定的GLP-1 RAs和安慰剂相比，替西帕肽在降低HbA1c和体重方面具有统计学意义上的显著性。总体而言，替西肽的安全性与GLP-1RAs相似。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.