Liraglutide add-on to metformin sustained glycaemic control in T2D

Adding liraglutide to metformin led to a significantly longer duration of glycaemic control in patients with type 2 diabetes (T2D) compared with an oral antidiabetic drug (OAD), according to the LIRA-PRIME* study presented at ADA 2020.

This phase IV, open-label, active-controlled trial analysed 1,991 patients with T2D (mean age 57.4 years, 47.6 female, HbA_1c 7.5–9.0 percent) who were receiving ≥1,500 mg metformin for ≥60 days before randomization. Participants were randomly assigned to receive either liraglutide (n=996) or an OAD (n=995) in addition to metformin for 104 weeks. [ADA 2020, abstract 922-P]

The most common OADs used were sodium-glucose co-transporter-2 inhibitors (SGLT-2is; 47.9 percent) and dipeptidyl peptidase 4 inhibitors (DPP-4is; 39.7 percent), while 10.8, 1.1, and 0.5 percent were on sulfonylureas, thiazolidinediones, and α-glucosidase inhibitors, respectively.

Patients treated with liraglutide had a significantly longer time to inadequate glycaemic control (HbA_1c >7.0 percent) than those treated with OAD (median 109 vs 65 weeks; p<0.0001).

A significantly lower risk of inadequate glycaemic control (41.8 percent vs 55.0 percent; p<0.0001) and premature treatment discontinuation (53.4 percent vs 62.7 percent; p<0.0001) was observed in the liraglutide than the OAD group.

Liraglutide recipients also achieved a longer median time to premature treatment discontinuation for any reason compared with OAD recipients (80 vs 52 weeks; p<0.0001).

Serious adverse event incidence and hypoglycaemic episodes were comparable between the treatment groups. However, gastrointestinal events leading to treatment discontinuation occurred more frequently in the liraglutide vs the OAD group (6.0 percent vs 1.0 percent).

“[Maintaining] glycaemic control [is important to] improve patient outcomes, delaying the requirement for further treatment intensification, and simplifying the management of advancing T2D in primary care,” said lead author Dr Jeff Unger from the Catalina Research Institute LLC in Montclair, California, US.

However, should treatment intensification be required on top of first-line metformin, data to guide this in primary care are lacking, Unger pointed out. “[As] the majority of patients with T2D are managed in primary care, … [our findings showed that] within global primary care settings, longer-lasting glycaemic control [was achieved] with liraglutide than with an OAD, when added to metformin,” said Unger.