Comparative effectiveness of dulaglutide versus liraglutide in Asian type 2 diabetes patients: a multi-institutional cohort study and meta-analysis

Abstract

Background: Head-to-head comparison of clinical effectiveness between dulaglutide and liraglutide in Asia is limited. This study was aimed to assess the real-world comparative effectiveness of dulaglutide versus liraglutide.

Methods: We conducted a retrospective cohort study by utilizing multi-institutional electronic medical records to identify real-world type 2 diabetes patients treated with dulaglutide or liraglutide during 2016-2018 in Taiwan and followed up until 2019. Effectiveness outcomes were assessed at every 3 months in the 1-year follow-up. Propensity score techniques were applied to enhance between-group comparability. Significant differences in changes of effectiveness outcomes between treatment groups during the follow-up were examined and further analyzed using mixed-model repeated-measures approaches.

Results: A total of 1512 subjects receiving dulaglutide and 1513 subjects receiving liraglutide were identified. At 12 months, significant HbA1c changes from baseline were found in both treatments (dulaglutide: - 1.06%, p < 0.001; liraglutide: - 0.83%, p < 0.001), with a significant between-group difference (- 0.23%, 95% confidence interval - 0.38 to - 0.08%, p < 0.01). Both treatments yielded significant declines in weight, alanine aminotransferase level, and estimated glomerular filtration rate from baseline (dulaglutide: - 1.14 kg, - 3.08 U/L and - 2.08 mL/min/1.73 m², p < 0.01; liraglutide: - 1.64 kg, - 3.65 U/L and - 2.33 mL/min/1.73 m², p < 0.001), whereas only dulaglutide yielded a significant systolic blood pressure reduction (- 2.47 mmHg, p < 0.001). Between-group differences in changes of weight, blood pressure, and liver and renal functions at 12 months were not statistically significant.

Conclusions: In real-world T2D patients, dulaglutide versus liraglutide was associated with better glycemic control and comparable effects on changes of weight, blood pressure, and liver and renal functions.

Keywords: Clinical effectiveness and meta-analysis; Dulaglutide; Liraglutide.

Fig. 1

Flow chart of cohort selection and outline of analytic procedures. IPTW inverse probability of treatment weighting, SMRW standardized mortality ratio weighting

Fig. 2

Changes in clinical effectiveness at every 3 months after initiation of dulaglutide or liraglutide (based on the propensity-score-matched sample). a HbA1c values from baseline to month 12, b change in HbA1c from baseline to month 12, c body weights from baseline to month 12, d change in body weight from baseline to month 12, e systolic blood pressure (SBP) from baseline to month 12, f change in SBP from baseline to month 12, g alanine aminotransferase (ALT) values from baseline to month 12, h change in ALT from baseline, i estimated glomerular filtration rates (eGFR) from baseline to month 12, and j change in eGFR from baseline to month 12. Index date refers to the first date of initiation of dulaglutide or liraglutide. *, **, and *** refer to p value < 0.05, < 0.01, and < 0.001, respectively

Fig. 2

Changes in clinical effectiveness at every 3 months after initiation of dulaglutide or liraglutide (based on the propensity-score-matched sample). a HbA1c values from baseline to month 12, b change in HbA1c from baseline to month 12, c body weights from baseline to month 12, d change in body weight from baseline to month 12, e systolic blood pressure (SBP) from baseline to month 12, f change in SBP from baseline to month 12, g alanine aminotransferase (ALT) values from baseline to month 12, h change in ALT from baseline, i estimated glomerular filtration rates (eGFR) from baseline to month 12, and j change in eGFR from baseline to month 12. Index date refers to the first date of initiation of dulaglutide or liraglutide. *, **, and *** refer to p value < 0.05, < 0.01, and < 0.001, respectively

Fig. 3

Forest plot of 12-month difference in HbA1c between dulaglutide and liraglutide. a All studies (including randomized controlled trials [RCTs] and observational studies), b RCTs only, and c observational studies only