OBJECTIVES:  To conduct a decision-focused NMA of the efficacy and safety of the DPP4 alogliptin compared to other DPP4s used in UK clinical practice (sitagliptin, saxagliptin, linagliptin, vildagliptin) in triple therapy for the treatment of T2DM in combination with metformin (Met) and sulphonylurea (SU). METHODS:  A targeted systematic review identified relevant RCTs comparing (Met+SU) triple therapies involving DPP4s against each other or placebo in T2DM. Outcomes were change in HbA1c from baseline (primary), weight change, change in FPG, and proportion of patients ≥1 hypoglycaemic episode. Extensive Bayesian NMAs approaches included individual treatment comparisons, grouped DPP4 versus alogliptin comparisons and novel quasi-random effect models. Frequentist methods validated Bayesian findings. Sensitivity analysis (sub-group and meta-regression) was conducted to account for heterogeneity and confounding factors (e.g. baseline HbA1c, study outliers, and study quality). RESULTS:  Eight RCTs met inclusion criteria for the NMA. All analyses across all endpoints produced the same result– alogliptin is equivalent to all other DPP4s in triple (Met+SU) therapy. Differences were small and not statistically significant. Maximum calculated difference between any DPP4 in average change in HbA1c was just 0.14%. Total reductions in HbA1c were similar to previous published NMAs of DPP4s for T2DM in triple therapy (-0.62% to -0.69%). Deletion of trial outliers via leverage plots improved heterogeneity whilst not changing underlying results. For all other outcomes, alogliptin was shown to be comparable to alternative DPP4s. CONCLUSIONS:  The comparable efficacy of anti-diabetes treatments in triple therapy have previously been reported, and the decision-focused NMA performed in this study has further confirmed there are no significant differences in change in HbA1c, body weight, FPG and episodes of hypoglycaemia between alogliptin and the other DPP4s at their recommended doses in UK clinical practice. The advantage of a decision-focused NMA is its focus on direct data of interest for HTA in a specific country context.