Indirect comparison between dapagliflozin, sitagliptin and saxagliptin for the treatment of patients with type 2 diabetes mellitus inadequately controlled with metformin

Abstract

Objective: To conduct a systematic review and an indirect comparison meta-analysis to assess whether there are differences between the addition of dapagliflozin to metformin or dipeptidyl dipeptidase-4 inhibitor (sitagliptin and saxagliptin) to metformin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled. Methods: A literature search was realized in the data[1]base MEDLINE, LILACS and CENTRAL searched for randomized trials that compared dapagliflozin versus glipizide, and also sitagliptin and saxagliptin against the same comparator (glipizide). The literature search found 445 articles of wich 16 were selected. After these five articles were included in the final analyze. The data above were analyzed by two researchers. The data relating to outcomes of interest were extracted directly from the publications where feasible an indirect comparison meta-analysis was also conducted, to verify if there are any difference between the groups. The outcomes of interest were mean change in glycated hemoglobin from baseline, percentage of patients achieving control, percentage of patients developing hypoglycemia and mean change relative to baseline weight. Results: The three drugs analyzed (dapagliflozin, saxagliptin and sitagliptin) demonstrated non-inferiority compared to the control drug (glipizide), with advantages regarding weight gain and hypoglycemia. In the indirect comparison between sitagliptin and dapagliflozin, dapaglifozin was showed a difference in the frequency of hypoglycemia, but between saxagliptin and dapagliflozin, the development of hypoglycemia was equivalent. Conclusions: Dapagliflozin led to reductions in HbA1c similar to dipeptidyl dipeptidase-4 inhibitor (sitagliptin and saxagliptin). Regarding weight change and percentage of patients who did not achieve optimal glycemic control, there were also no differences between the comparators.