Abstract
ObjectiveTo evaluate the comparative efficacy and safety of saxagliptin for type 2 diabetes (T2D).MethodsA systematic search of PubMed, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov and two Chinese databases for randomized controlled trials (RCTs) comparing saxagliptin with placebo or active comparators was performed up to July 2017. A complementary search was done to cover literature until March 2018. For continuous data, estimates were pooled using inverse variance methodology to calculate weighted mean differences (WMDs). Dichotomous data were presented as Mantel-Haenzel risk ratios (RRs).ResultsThirty-nine references of 30 RCTs involving 29,938 patients were analyzed. Compared with placebo, saxagliptin significantly reduced glycated hemoglobin (HbA1c, WMD -0.52%, 95% CI -0.60 to -0.44) and fasting plasma glucose (WMD -13.78 mg/dL, 95% CI -15.31 to -12.25), and increased the proportion of patients achieving HbA1c <7% (RR 1.64, 95% CI 1.53 to 1.75). When combined with submaximal-dose metformin, saxagliptin significantly increased the proportion of patients achieving HbA1c <7% compared with acarbose (RR 2.38, 95% CI 1.17 to 4.83) and uptitrated metformin (RR 1.30, 95% CI 1.04 to 1.63). Saxagliptin was similar to other DPP-4 inhibitors but inferior to liraglutide and dapagliflozin on glycemic control. Saxagliptin significantly decreased the incidences of overall adverse events compared with acarbose (RR 0.71, 95% CI 0.57 to 0.89) and liraglutide (RR 0.41, 95% CI 0.24 to 0.71) when added to metformin. Weight gain and hypoglycemia with saxagliptin was slightly but significantly higher than placebo and lower than sulfonylureas. Saxagliptin did not increase the risk of arthralgia, heart failure, pancreatitis and other adverse events.ConclusionsGenerally, saxagliptin has similar efficacy compared with most oral antidiabetic drugs and may be more effective than acarbose, while having a better safety profile than both acarbose and sulfonylureas.
Highlights
Type 2 diabetes (T2D) is a chronic disease rapidly increasing in prevalence that imposing enormous medical and economic burdens on on individuals, families, and national health systems worldwide
Saxagliptin significantly reduced glycated hemoglobin (HbA1c, weighted mean differences (WMDs) -0.52%, 95% confidence intervals (CIs) -0.60 to -0.44) and fasting plasma glucose (WMD -13.78 mg/dL, 95% CI -15.31 to -12.25), and increased the proportion of patients achieving HbA1c
When combined with submaximal-dose metformin, saxagliptin significantly increased the proportion of patients achieving HbA1c
Summary
Type 2 diabetes (T2D) is a chronic disease rapidly increasing in prevalence that imposing enormous medical and economic burdens on on individuals, families, and national health systems worldwide. It is estimated that approximately 415 million people in the world had diabetes in 2015, and this figure is projected to increase to 642 million by 2040 [1]. Health spending on diabetes accounted for 11.6% of total health expenditure worldwide in 2015 [2]. Because of the progressive nature of diabetes, clinicians and patients often experience difficulty in achieving and sustaining glycemic control. Utilization of antidiabetic drugs should be based on the individual patient’s characteristics and preferences and balance the need to optimize the benifits of glycaemic control with the need to limit the risk of adverse effects
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