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T2D patients on combination therapy benefit
in switch from sitagliptin to liraglutide
BY BRIAN HOYLE
S
witching from sitagliptin to liraglutide, in combina-
tion with metformin, improved control of hypogly-
caemia and resulted in greater weight loss in patients
with type 2 diabetes, reported Dr Maximo Maislos at the
annual meeting of the Endocrine Society.
Results of a randomised, double-blind, double-
dummy, active-controlled 26-week trial have indicated
that liraglutide can be used as an add-on to metformin
for patients with type 2 diabetes who have remained
hyperglycaemic.
“Switching from sitagliptin to liraglutide resulted in
superior [glycated haemoglobin] and body weight reduc-
tions, compared with continued sitagliptin treatment,”
said Dr Maximo Maislos of Ben-Gurion University,
Beer-Sheva, Israel.
The LIRA-SWITCH trial (Efficacy and Safety of
Switching From Sitagliptin to Liraglutide in Subjects
With Type 2 Diabetes Not Achieving Adequate Glycae-
mic Control on Sitagliptin and Metformin) involved 407
patients. The majority (60%) were male; mean age was
56 years and mean body mass index was 32 kg/m
2
. The
subjects had all been treated with sitagliptin (100 mg/
day) and metformin (greater than or equal to 1500 mg/
day or a maximum tolerated dose greater than or equal to
1000 mg/day) for at least 90 days. Hyperglycaemia had
not been well controlled, with a mean haemoglobin A
1C
(HbA
IC
) level of 0.08. The mean duration of type 2 dia-
betes was 8 years.
Subjects were randomised to continued sitagliptin
along with metformin (n = 204) or liraglutide (1.8 mg
daily) along with metformin (n = 203).
After 26 weeks of treatment, reduction in HbA
IC
was
significantly greater in the liraglutide arm than in the sit-
agliptin arm (0.014 vs 0.005%; estimated treatment dif-
ference [ETD], –0.006 95% confidence interval, –0.008
to –0.004; P < 0.0001). Those receiving liraglutide had
statistically significantly greater weight loss, compared
with those who continued on sitagliptin.
The less than 0.07 and less than or equal to 0.06 target
levels of HbA
IC
were achieved by 50.6% and 29.5%,
respectively, of patients in the liraglutide arm. These
percentages were significantly higher than the respec-
tive 26.9% and 9.9% of patients in the sitagliptin arm
(P < 0.0001 for both). Fasting plasma glucose levels
were significantly reduced with liraglutide treatment
while decreases in systolic and diastolic blood pressure
were similar in the two study arms.
Adverse events (AEs) occurred more often in the
liraglutide group than in the sitagliptin group (68.8% vs
56.9%). Thirteen patients receiving liraglutide discontin-
ued treatment, compared with five in the sitagliptin arm.
The most commonAEs in the liraglutide group were gas-
trointestinal disorders, principally nausea (21.8% with
liraglutide vs 7.8% with sitagliptin) and diarrhoea (16.3%
with liraglutide vs 9.3% with sitagliptin), followed by
decreased appetite (8.9% vs 3.4%, respectively). These
AEs tended to subside within the first few weeks of
treatment.
Serious AEs occurred in eight patients in both arms.
Rescue medication was needed for 30 patients receiv-
ing sitagliptin and 11 patients receiving liraglutide. No
cases of pancreatitis were reported. In the sitagliptin
group, one subject each developed bladder cancer and
squamous cell carcinoma. Nocturnal hypoglycaemia did
not develop in either trial arm.
Funding was provided by liraglutide maker Novo Nordisk.
Dr Maislos had no disclosures.
ENDO 2016 Conference
1–4 April 2016 • Boston, USA
With over 9000 attendees, nearly 3000 abstracts
and over 200 other sessions, ENDO2016 is the
leading global meeting on endocrinology research
and clinical care.
F
rontline
M
edical
N
ews
reporters share all the highlights of this meeting.
Switching from sitagliptin to liraglutide
resulted in superior [glycated haemoglobin]
and body weight reductions, compared with
continued sitagliptin treatment.
C
linical
E
ndocrinology
N
ews
• Vol. 9 • No. 1 • 2016
10
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