Safety and efficacy of once weekly dipeptidyl-peptidase-4 inhibitor trelagliptin in type-2 diabetes: A meta-analysis.

BACKGROUND & AIMS: Pooled systematic analysis of safety and efficacy data of trelagliptin in type-2 diabetes (T2DM) is lacking. We undertook this meta-analysis to address this issue.

METHODS: Electronic databases were searched for RCTs involving people with T2DM receiving trelagliptin in study arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in pre and post-meal glucose levels, glycaemic targets, lipid parameters and adverse events.

RESULTS: From initially screened 63 articles, data from 6 RCTs involving 981 patients was analysed [3 in active control group (ACG) defined as having alogliptin, sitagliptin, linagliptin, teneligliptin, anagliptin or vildagliptin as active comparator; 2 in passive control group (PCG) defined as having placebo as controls; 1 study had both ACG and PCG]. HbA1c reduction by trelagliptin was comparable to ACG [MD 0.06% (95% CI: -0.03 - 0.16); P = 0.20; I2  = 0%], but superior to PCG [MD -0.54% (95% CI: -0.64 to -0.44); P < 0.01; I2  = 22%]. Fasting blood glucose lowering with trelagliptin was inferior to ACG [MD +6.98 mg/dl (95%CI: 2.55-11.42); P = 0.002; I2  = 0%], but superior to PCG [MD -6.11 mg/dl (95%CI: -12.00 to -0.23); P = 0.04; I2  = 54%]. Glycated albumin lowering was similar to ACG [MD 0.03% (95%CI: -0.47 - 0.53); P = 0.92; I2  = 0%], but superior to PCG [MD -2.31% (95% CI: -2.86 to -1.76); P < 0.01; I2  = 0%]. Treatment-emergent adverse events [Risk ratio (RR) 1.18 (95%CI:0.63-2.21); P = 0.59; I2  = 19%] and severe adverse events [RR 1.75 (95%CI: 0.90-3.40); P = 0.10; I2  = 0%] were comparable among groups.

CONCLUSION: Once weekly trelagliptin has good glycaemic efficacy and well tolerated in people with T2DM.