OBJECTIVES To conduct decision-focused mixed treatment comparisons (MTCs) of the relative efficacy and safety of a new DPP-4 inhibitor (DPP-4i), alogliptin 25mg daily compared to current DPP-4i’s used in UK clinical practice (sitagliptin, saxagliptin, linagliptin, vildagliptin) in dual therapy for the treatment of type 2 diabetes mellitus (T2DM) in combination with metformin or sulfonylurea (SU).    METHODS A decision-focused systematic review was conducted to identify RCTs comparing the DPP-4i’s in combination with metformin or SU compared to metformin or SU alone or against each other in the target patient population. Separate Bayesian MTCs were conducted for each DPP-4i combination. Outcomes of interest were change in HbA from baseline (primary), weight change, proportion of patients HbA <7%, and proportion of patients ≥1 hypoglycaemic episode.  Fixed and random effects models were run with sensitivity analysis conducted to account for confounding factors (study length, baseline HbA), study heterogeneity and inconsistency.   RESULTS Twenty-five RCTs met inclusion criteria for the MTCs. For the primary outcome, fixed effects models suffered from heterogeneity problems whilst random effect models struggled to estimate between trial heterogeneity. However, the base case and all sensitivity analyses showed the same results - alogliptin in combination with metformin or SU had a high probability of non-inferiority to comparator DPP-4’s in HbA change (61%-100% at a 0.3% HbAmargin). Deletion of trial outliers via leverage plots vastly improved model fit within fixed effects models whilst not changing underlying results. For all other outcomes alogliptin was shown to be comparable to alternative DPP-4i’s.   CONCLUSIONS Alogliptin 25mg has comparable efficacy and safety as other DPP-4i’s at their recommended doses in UK clinical practice. This is in line with expectations based on prior meta-analyses of DPP-4i’s. The use of a decision-focused approach to the MTC enables a focus on the data of direct interest for clinical and HTA based decision making.