Effectiveness of Switching from a DPP-4 Inhibitor to the Human GLP-1 Analogue Liraglutide in Patients with Type 2 Diabetes

Abstract

Data from EVIDENCE, a post-marketing study in France were used to assess effectiveness of switching from a DPP-4 inhibitor (DPP-4i) to liraglutide in patients with T2D. EVIDENCE is a multicentre, observational, outpatient study requested by the French National Health Authority to evaluate efficacy and safety of liraglutide. It aims to determine the percentage still taking liraglutide and with A1c <7% after 2 years. Statistical analyses were: quantitative variables, via normality Kolmogorov-Smirnov test; comparisons of 2 dependent groups, via Wilcoxon signed rank test; paired qualitative variables, via McNemar test. Data were collected from 3152 subjects, of whom 1261 (40%) received DPP-4i prior to liraglutide; 1002 (32%) switched from DPP-4i to liraglutide at study start. Baseline characteristics of subjects who switched and were still on liraglutide at study end (n=624) are in Table 1 (above); reductions in A1c (–0.85%, p<0.0001), fasting plasma glucose (–0.28g/L, p<0.0001) and body weight (–3.60kg, p<0.0001) were significant. An increased percentage reached A1c <7% after switching to liraglutide (31.7% at study end vs. 9.7% at baseline; p<0.0001). Withdrawals (21.4% overall) were mostly due to gastrointestinal disorders at study start. Switching from a DPP-4i to liraglutide improved glycemic control and weight in this observational study. In a previous randomized trial, sitagliptin to liraglutide switch provided significant A1c (–0.5%; p<0.0001) and weight reductions (–2.5 kg; p<0.0001). The greater reductions in this observational study may reflect different baseline characteristics and concomitant diabetes medications. These data support the benefits of switching from a DPP-4i to a GLP-1 analogue. Table 1Baseline characteristics of subjects switching from a DPP-4i to liraglutide and still on liraglutide treatment at study end Baseline characteristics N 624 Age, years 58±10 Diabetes duration, years 9.2±5.8 A1c, % 8.4±1.4 Fasting plasma glucose, g/L 1.8±0.6 Body weight, kg 96±18 BMI, kg/m2 34±6 Proportion of patients with A1c <7% 9.7% Data are mean ± SD. Open table in a new tab Data are mean ± SD.