Endocrinology News

C linical E ndocrinology N ews • Vol. 9 • No. 1 • 2016 10 CONFERENCE COVERAGE

ENDO 2016 Conference 1–4 April 2016 • Boston, USA

T2D patients on combination therapy benefit in switch from sitagliptin to liraglutide

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.

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. Switching from sitagliptin to liraglutide resulted in superior [glycated haemoglobin] and body weight reductions, compared with continued sitagliptin treatment.

Funding was provided by liraglutide maker Novo Nordisk. Dr Maislos had no disclosures.