BAYESIAN NETWORK META-ANALYSIS (NMA) TO ASSESS THE RELATIVE EFFICACY OF CANAGLIFLOZIN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS (T2DM) INADEQUATELY CONTROLLED WITH INSULIN
Author(s)
Taieb V1, Pacou M2, Schroeder M3, Nielsen AT4, Neslusan C5, Schubert A6
1Amaris, London, UK, 2Amaris, Paris, France, 3Janssen UK, High Wycombe, UK, 4Janssen-Cilag A/S, Birkerød, Denmark, 5Janssen Global Services, LLC, Raritan, NJ, USA, 6Janssen-Cilag Poland, Warsaw, Poland
OBJECTIVES: To assess the relative efficacy of canagliflozin, a sodium glucose co-transporter 2 inhibitor (SGLT2) as add-on to insulin +/- oral antihyperglycaemic drugs for the treatment of T2DM compared to dipeptidyl peptidase-4 inhibitors (DPP-4s), glucagon-like peptide-1 receptor agonists (GLP-1s), sulphonylureas, pioglitazone, and other SGLT2 inhibitors, using Bayesian NMA methods. METHODS: A systematic literature review was conducted according to NICE guidelines and available data on HbA1c, weight and systolic blood pressure (SBP) were extracted. Networks were based on treatment- and dose-specific nodes, except for sulphonylureas where doses were combined. Selection of fixed versus random effects was based on the deviance information criterion. Results were interpreted based on absolute differences and Bayesian probabilities for treatments to perform better than others (P), where P≤30% indicated a smaller effect and P≥70% a larger effect. RESULTS: Eighteen trials reported results at 26 +/- 4 weeks. HbA1c reductions were highest for liraglutide 1.8mg, pioglitazone 45mg and glibenclamide. Canagliflozin 300mg had greater HbA1c reductions than all remaining comparators, except for exenatide where the reduction was similar. Canagliflozin 100mg had a greater reduction than dapagliflozin 5mg, vildagliptin, saxagliptin and lixisenatide and a similar reduction versus DPP-4s, glimepiride, lixisenatide, pioglitazone 30mg, metformin and dapagliflozin 10mg. Both dosages of canagliflozin were associated with greater weight loss than DPP-4s, glibenclamide, pioglitazone 30mg and dapagliflozin (Δ=–2.13 to –3.45kg; Δ=–7.61 to –8.25kg; Δ=–3.34 to –3.95kg; Δ=–0.44 to –1.73kg, respectively). Weight reductions were highest for liraglutide 1.8mg and exenatide 10μg. Both dosages of canagliflozin had higher SBP reductions than dapagliflozin and saxagliptin; at least similar reductions were estimated versus exenatide 10μg. CONCLUSIONS: These results suggest that canagliflozin is a valuable treatment option as add-on to insulin therapy, as it provides not only similar or better glucose lowering than many other options, but also weight loss.
Conference/Value in Health Info
2015-11, ISPOR Europe 2015, Milan, Italy
Value in Health, Vol. 18, No. 7 (November 2015)
Code
PDB7
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Diabetes/Endocrine/Metabolic Disorders