SYSTEMATIC LITERATURE REVIEW AND INDIRECT TREATMENT COMPARISON OF THE EFFICACY OF SEMAGLUTIDE VERSUS EMPAGLIFLOZIN AS ADD-ON TO BASAL INSULIN
Author(s)
Kanters S1, Wilkinson L2, Lopes S3, Popoff E1, Jansen JP1, Ploug UJ2
1Precision Health Economics, Vancouver, BC, Canada, 2Novo Nordisk A/S, Søborg, Denmark, 3Novo Nordisk Health Care AG, Copenhagen, Denmark
OBJECTIVES: To conduct a systematic literature review (SLR) and network meta-analysis (NMA) to determine the comparative efficacy and safety of semaglutide relative to all SGLT-2 inhibitors among adults with type 2 diabetes with inadequate glycaemic control on basal insulin. METHODS: Systematic searches were conducted, up to April 2016, in: EMBASE, MEDLINE, and CENTRAL; and in major conferences up to September 2016. Eligible studies were randomized trials with ≥20 weeks of treatment, evaluating the efficacy and/or safety of semaglutide once-weekly or SGLT-2 inhibitors. The sparse evidence base, only allowing for fixed-effects Bayesian indirect treatment comparisons (ITC), a form of NMA, to be used for change in HbA1c, weight and fasting plasma glucose (FPG) at 30 weeks. Safety outcomes were only reported at 30 weeks in SUSTAIN 5 and 78 weeks in EMPA-REG BASALTM RESULTS: From the TM, were included in the evidence base. Four trials of SGLT-2is as add-on to mixed insulin regimens were excluded. The evidence base was composed of two doses of each semaglutide and empagliflozin, and placebo. For change from baseline in HbA1c, semaglutide 1.0mg once-weekly was more efficacious than empagliflozin. The mean differences (MDs) relative to empagliflozin 10mg and 25mg were -0.60% (95% credible interval [CrI]: -0.90, -0.29) and -0.48% (95% CrI: -0.76, -0.19), respectively. For weight-loss, semaglutide 1.0mg once-weekly was more efficacious than both doses of empagliflozin, with equivalent MDs of -2.23 kg and 95% CrIs within -3.72 and -0.74. Although semaglutide led to larger decreases in FPG, differences were not statistically significant. CONCLUSIONS: Semaglutide showed larger reductions in HbA1c and body weight than empagliflozin when used as an add-on to basal insulin; however, the evidence base was too sparse to conduct safety analyses.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PDB4
Topic
Clinical Outcomes, Epidemiology & Public Health
Topic Subcategory
Comparative Effectiveness or Efficacy, Safety & Pharmacoepidemiology
Disease
Diabetes/Endocrine/Metabolic Disorders