COMPARATIVE EFFICACY OF ONCE-WEEKLY ICOSEMA VERSUS BASAL INSULINS, FIXED-RATIO COMBINATIONS, PREMIX INSULINS AND CO-FORMULATIONS IN INSULIN-NAïVE ADULTS WITH TYPE 2 DIABETES: A BAYESIAN NETWORK META-ANALYSIS
Author(s)
Saikrishna Kandalam, PhD1, Corinne Reun, MSc2, Martin Bøg, PhD3, Palvi Gupta, MPharm4, Sunita Nair, PhD4.
1Novo Nordisk, Bengaluru, India, 2Clarivate Analytics, London, United Kingdom, 3Novo Nordisk A/S, Søborg, Denmark, 4Clarivate Analytics, Bengaluru, India.
1Novo Nordisk, Bengaluru, India, 2Clarivate Analytics, London, United Kingdom, 3Novo Nordisk A/S, Søborg, Denmark, 4Clarivate Analytics, Bengaluru, India.
OBJECTIVES: To assess comparative efficacy of once-weekly IcoSema (insulin icodec/semaglutide) versus comparators in insulin-naïve adults with type 2 diabetes (T2D) at 26±4 and 40±4 weeks.
METHODS: A PRISMA-aligned systematic literature review (SLR) [Embase, Medline, Cochrane; February 2026] identified randomized controlled trials in insulin-naïve adults with T2D comparing IcoSema, daily basal insulins (glargine U100/U300, degludec, detemir, Neutral Protamine Hagedorn [NPH]), fixed-ratio combinations (FRCs: IDegLira, IGlarLixi), premix/co-formulations (IDegAsp, BIAsp 30/70, lispro mix 75/25), and once-weekly basal insulins (icodec, efsitora alfa). Network meta-analysis (NMA) feasibility assessment (FA) evaluated network connectivity, comparability, and data availability. Bayesian NMA (WinBUGS) used fixed/random-effects models as appropriate. Results reported as mean difference (MD) ranges for HbA1c and body weight at 26±4 and 40±4 weeks across the global network; significance assessed by 95% credible intervals (CrIs).
RESULTS: SLR identified 75 studies; 46 retained for FA; 45 for NMA (26 basal; 19 FRC/premix/co-formulation). At 26±4 weeks, networks were feasible for HbA1c and body weight; 40±4-week networks had limited weight data. At 26±4 weeks, IcoSema significantly reduced HbA1c versus daily basal insulins (MD range: −1.02% to −1.12%), once-weekly basal insulins (−0.86% to −1.05%), and FRCs/premix/co-formulations (−0.56% to −0.92%); and body weight versus daily basal insulins (−2.38 to −4.31 kg), once-weekly basal insulins (−4.80 to −4.81 kg), and FRCs/premix/co-formulations (−2.52 to −5.21 kg); all differences were statistically significant. At 40±4 weeks, IcoSema reduced HbA1c versus daily basal insulins (−0.87% to −1.07%), once-weekly basal insulins (−0.68% to −1.03%), and FRCs/premix/co-formulations (−0.61% to −0.82%); only BIAsp 30/70 twice-daily (BID) was not statistically significant. Body weight favoured IcoSema versus daily basal insulins (−3.53 to −4.60 kg) and FRCs/premix/co-formulations (−2.01 to −6.22 kg); estimates versus once-weekly basal insulins were not available.
CONCLUSIONS: In insulin-naïve adults with T2D, once-weekly IcoSema showed greater reductions in HbA1c and body weight versus all comparators at 26±4 weeks, with generally consistent 40±4-week results where estimable.
METHODS: A PRISMA-aligned systematic literature review (SLR) [Embase, Medline, Cochrane; February 2026] identified randomized controlled trials in insulin-naïve adults with T2D comparing IcoSema, daily basal insulins (glargine U100/U300, degludec, detemir, Neutral Protamine Hagedorn [NPH]), fixed-ratio combinations (FRCs: IDegLira, IGlarLixi), premix/co-formulations (IDegAsp, BIAsp 30/70, lispro mix 75/25), and once-weekly basal insulins (icodec, efsitora alfa). Network meta-analysis (NMA) feasibility assessment (FA) evaluated network connectivity, comparability, and data availability. Bayesian NMA (WinBUGS) used fixed/random-effects models as appropriate. Results reported as mean difference (MD) ranges for HbA1c and body weight at 26±4 and 40±4 weeks across the global network; significance assessed by 95% credible intervals (CrIs).
RESULTS: SLR identified 75 studies; 46 retained for FA; 45 for NMA (26 basal; 19 FRC/premix/co-formulation). At 26±4 weeks, networks were feasible for HbA1c and body weight; 40±4-week networks had limited weight data. At 26±4 weeks, IcoSema significantly reduced HbA1c versus daily basal insulins (MD range: −1.02% to −1.12%), once-weekly basal insulins (−0.86% to −1.05%), and FRCs/premix/co-formulations (−0.56% to −0.92%); and body weight versus daily basal insulins (−2.38 to −4.31 kg), once-weekly basal insulins (−4.80 to −4.81 kg), and FRCs/premix/co-formulations (−2.52 to −5.21 kg); all differences were statistically significant. At 40±4 weeks, IcoSema reduced HbA1c versus daily basal insulins (−0.87% to −1.07%), once-weekly basal insulins (−0.68% to −1.03%), and FRCs/premix/co-formulations (−0.61% to −0.82%); only BIAsp 30/70 twice-daily (BID) was not statistically significant. Body weight favoured IcoSema versus daily basal insulins (−3.53 to −4.60 kg) and FRCs/premix/co-formulations (−2.01 to −6.22 kg); estimates versus once-weekly basal insulins were not available.
CONCLUSIONS: In insulin-naïve adults with T2D, once-weekly IcoSema showed greater reductions in HbA1c and body weight versus all comparators at 26±4 weeks, with generally consistent 40±4-week results where estimable.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO9
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)