Comparison of the efficacy and safety between DPP-4 Inhibitors and GLP-1 analogues for treatment of type 2 diabetes mellitus: A meta-analysis / 中国药学杂志

ABSTRACT

OBJECTIVE: To systematically review the efficacy and safety of dipeptidyl peptidase-4 (DPP-4) inhibitors versus glucagon like peptide-1 (GLP-1) receptor agonists for type 2 diabetes mellitus (T2DM). METHODS: Databases including EMbase, PubMed, The Cochrane Library, Clinical Trial, CBM, CNKI and WanFang Data, were searched electronically for randomized controlled trials (RCTs) of DPP-4 inhibitors versus GLP-1 receptor agonists for T2DM up to December 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using RevMan 5.3 soft ware. RESULTS: A total of 13 RCTs were included. The results of Meta-analysis showed that compared with DPP-4- inhibitors, GLP-1 receptor agonists were more effective in reducing the levels of fasting plasma glucose [MD = 0.93, 95% CI (0.48, 1.38), P < 0.0001] and glycated hemoglobin [ MD = 0.53, 95% CI (0.34, 0.73), P<0.00001] andBMI [MD = 1.53, 95% CI(0.83, 2.22), P <0.001]. However, DPP-4 inhibitors were more effective than GLP-1 receptor agonists in the reducing the 2-hour postprandial blood glucose level. And GLP-1 receptor agonists were more prone to cause gastrointestinal adverse reactions than DPP-4 inhibitors [RR =0.44,95% CI (0.33, 0.59), P <0.0001]. CONCLUSION GLP-1 receptor agonists are superior to DPP-4 inhibitors in controlling the fasting plasma glucose and glycated hemoglobin levels and reducing the body weight of T2DM patients, while DPP-4 inhibitors have better efficacy in reducing 2-hour postprandial blood glucose level, with better tolerability.