Comparison of the Effectiveness of Dipeptidyl Peptidase 4 Inhibitors in Achieving the Target Level of Glycated Hemoglobin: a Systematic Review and Network Meta-Analysis

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Aims – to compare the efficacy of dipeptidyl peptidase 4 (DPP-4) inhibitors in achieving the target for glycated hemoglobin (HbA1c) level in patients with type 2 diabetes by monotherapy or by combination with metformin. Material and methods. This is a systematic review and network meta-analysis of randomized clinical trials (RCTs). Studies on the effectiveness of DPP-4 inhibitors (gliptins) compared with placebo and the combination of DPP-4 inhibitors with metformin compared with metformin were included. The endpoint was the percentage of patients (%) who achieved target HbA1c level. The size effect was represented by the logarithmic scale of the odds ratio (OR). The gliptins were ranked based on the values of surface under the cumulative ranking curve (SUCRA). Results. The 38 RCTs of sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin, gozogliptin, evogliptin were analyzed. The results showed a statistically significant benefit of alogliptin in monotherapy (OR compared with placebo – 5.77), in combination with metformin, both in the general population (OR compared with metformin – 7.45), and in naive and non-naive patients (OR – 2.84 and 12.61 compared to metformin, respectively). According to the SUCRA, alogliptin had the highest rating among DPP-4 inhibitors for in all subgroups. Conclusion. Thus, the systematic review showed the superiority of alogliptin over other DPP-4 inhibitors in monotherapy, as well as in combination with metformin, both in the general population and in naive and previously treated subgroups of patients with type 2 diabetes.