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Comparative Efficacy of Adding Sitagliptin to Metformin, Sulfonylurea or Dual Therapy: A Propensity Score-Weighted Cohort Study.

Mamza J, Mehta R, Donnelly R, Idris I - Diabetes Ther (2015)

Bottom Line: The glycemic efficacy was a measure of average treatment effects obtained from multivariable linear regression models and propensity score-matching analysis.MET only: -0.5% vs. -0.7%, P < 0.001).In a real-world general practice setting, sitagliptin was effective in patients with suboptimal glycemic control with MET, SU or dual therapy, maximum between 36 and 48 weeks, but in patients with HbA1c of >9% receiving MET + SU therapy, adding sitagliptin, as a third agent, conferred minimal benefit.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, UK.

ABSTRACT

Introduction: The aim of this study was to assess the efficacy of co-administering sitagliptin to patients with inadequate glycemic control following treatment with metformin (MET), sulfonylurea (SU), or MET + SU.

Methods: A cohort of 25,386 patients with type 2 diabetes mellitus (hemoglobin A1c [HbA1C] >53 mmol/mol or 7%), newly treated with sitagliptin between 2007 and 2013, was sourced from UK general practices via The Health Improvement Network database. Among these, eligible patients were segregated into three groups: MET (n = 3364), SU (n = 509), or MET + SU therapy (n = 5929). The relative efficacy of sitagliptin added to SU or MET + SU compared with sitagliptin added to MET monotherapy was assessed with regards to HbA1c and body weight changes from baseline up to 52 weeks. The glycemic efficacy was a measure of average treatment effects obtained from multivariable linear regression models and propensity score-matching analysis.

Results: A total of 9802 patients were included in the study. Overall, addition of sitagliptin 100 mg once daily resulted in 5.5 mmol/mol (0.5%) HbA1c reduction (P < 0.001) and 0.8 kg weight reduction at 1 year (P < 0.001). Efficacy was similar across the treatment groups, but in patients with baseline HbA1c ≥9% adding sitagliptin to MET + SU produced a significantly smaller reduction in HbA1c when compared to the reference group MET (MET + SU vs. MET only: -0.5% vs. -0.7%, P < 0.001). The mean HbA1c reduction from baseline within this subgroup of patients was not significantly different between SU and MET monotherapies (-0.8% vs. -0.7%, respectively, P = 0.4). Across treatment groups, HbA1c reductions with add-on sitagliptin occurred after 24 weeks of treatment with a peak reduction occurring between 36 and 48 weeks, and receded after week 48.

Conclusion: In a real-world general practice setting, sitagliptin was effective in patients with suboptimal glycemic control with MET, SU or dual therapy, maximum between 36 and 48 weeks, but in patients with HbA1c of >9% receiving MET + SU therapy, adding sitagliptin, as a third agent, conferred minimal benefit.

No MeSH data available.


Related in: MedlinePlus

Changes in HbA1c at 52 weeks from baseline HbA1c categories. HbA1c hemoglobin A1c, MET metformin, NS not significant, SU sulfonylurea
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Fig2: Changes in HbA1c at 52 weeks from baseline HbA1c categories. HbA1c hemoglobin A1c, MET metformin, NS not significant, SU sulfonylurea

Mentions: The ATEs with regards to HbA1c reduction produced by the co-administration of sitagliptin with SU (treatment Group B) and with MET + SU (treatment Group C) did not show any change in HbA1c value (0.02% [0.2 mmol/mol], P = 0.7, and 0.03% [0.3 mmol/mol], P = 0.2, respectively; Table 2) However, when stratified according to levels of HbA1c at baseline, a significant difference in the treatment efficacy was observed in the subgroup of HbA1c ≥9% at baseline (Table 2). In this HbA1c subgroup, after adjusting for confounders which include duration of GLT prior to starting sitagliptin, glycemic efficacy was significantly greater among patients in Group A compared with their counterparts in Group C (−0.7% vs. −0.5%, respectively, P < 0.001; Fig. 2). The mean reduction from baseline in HbA1c was not significantly different between the treatment Group B and the reference Group A (−0.8% vs. −0.7%, P = 0.4; Table 2). Hence, adding sitagliptin to MET + SU dual therapy (Group C) did not confer additional glucose-lowering effects compared with co-administration of sitagliptin with MET nor SU monotherapies.Fig. 2


Comparative Efficacy of Adding Sitagliptin to Metformin, Sulfonylurea or Dual Therapy: A Propensity Score-Weighted Cohort Study.

Mamza J, Mehta R, Donnelly R, Idris I - Diabetes Ther (2015)

Changes in HbA1c at 52 weeks from baseline HbA1c categories. HbA1c hemoglobin A1c, MET metformin, NS not significant, SU sulfonylurea
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4478174&req=5

Fig2: Changes in HbA1c at 52 weeks from baseline HbA1c categories. HbA1c hemoglobin A1c, MET metformin, NS not significant, SU sulfonylurea
Mentions: The ATEs with regards to HbA1c reduction produced by the co-administration of sitagliptin with SU (treatment Group B) and with MET + SU (treatment Group C) did not show any change in HbA1c value (0.02% [0.2 mmol/mol], P = 0.7, and 0.03% [0.3 mmol/mol], P = 0.2, respectively; Table 2) However, when stratified according to levels of HbA1c at baseline, a significant difference in the treatment efficacy was observed in the subgroup of HbA1c ≥9% at baseline (Table 2). In this HbA1c subgroup, after adjusting for confounders which include duration of GLT prior to starting sitagliptin, glycemic efficacy was significantly greater among patients in Group A compared with their counterparts in Group C (−0.7% vs. −0.5%, respectively, P < 0.001; Fig. 2). The mean reduction from baseline in HbA1c was not significantly different between the treatment Group B and the reference Group A (−0.8% vs. −0.7%, P = 0.4; Table 2). Hence, adding sitagliptin to MET + SU dual therapy (Group C) did not confer additional glucose-lowering effects compared with co-administration of sitagliptin with MET nor SU monotherapies.Fig. 2

Bottom Line: The glycemic efficacy was a measure of average treatment effects obtained from multivariable linear regression models and propensity score-matching analysis.MET only: -0.5% vs. -0.7%, P < 0.001).In a real-world general practice setting, sitagliptin was effective in patients with suboptimal glycemic control with MET, SU or dual therapy, maximum between 36 and 48 weeks, but in patients with HbA1c of >9% receiving MET + SU therapy, adding sitagliptin, as a third agent, conferred minimal benefit.

View Article: PubMed Central - PubMed

Affiliation: Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Nottingham, UK.

ABSTRACT

Introduction: The aim of this study was to assess the efficacy of co-administering sitagliptin to patients with inadequate glycemic control following treatment with metformin (MET), sulfonylurea (SU), or MET + SU.

Methods: A cohort of 25,386 patients with type 2 diabetes mellitus (hemoglobin A1c [HbA1C] >53 mmol/mol or 7%), newly treated with sitagliptin between 2007 and 2013, was sourced from UK general practices via The Health Improvement Network database. Among these, eligible patients were segregated into three groups: MET (n = 3364), SU (n = 509), or MET + SU therapy (n = 5929). The relative efficacy of sitagliptin added to SU or MET + SU compared with sitagliptin added to MET monotherapy was assessed with regards to HbA1c and body weight changes from baseline up to 52 weeks. The glycemic efficacy was a measure of average treatment effects obtained from multivariable linear regression models and propensity score-matching analysis.

Results: A total of 9802 patients were included in the study. Overall, addition of sitagliptin 100 mg once daily resulted in 5.5 mmol/mol (0.5%) HbA1c reduction (P < 0.001) and 0.8 kg weight reduction at 1 year (P < 0.001). Efficacy was similar across the treatment groups, but in patients with baseline HbA1c ≥9% adding sitagliptin to MET + SU produced a significantly smaller reduction in HbA1c when compared to the reference group MET (MET + SU vs. MET only: -0.5% vs. -0.7%, P < 0.001). The mean HbA1c reduction from baseline within this subgroup of patients was not significantly different between SU and MET monotherapies (-0.8% vs. -0.7%, respectively, P = 0.4). Across treatment groups, HbA1c reductions with add-on sitagliptin occurred after 24 weeks of treatment with a peak reduction occurring between 36 and 48 weeks, and receded after week 48.

Conclusion: In a real-world general practice setting, sitagliptin was effective in patients with suboptimal glycemic control with MET, SU or dual therapy, maximum between 36 and 48 weeks, but in patients with HbA1c of >9% receiving MET + SU therapy, adding sitagliptin, as a third agent, conferred minimal benefit.

No MeSH data available.


Related in: MedlinePlus