INTRODUCTION AND AIM Real-word data on the head-to-head comparisons among glucagon-like peptide-1 receptor agonists (GLP-1RA) are scant. Therefore, we aimed to compare the effectiveness of dulaglutide versus liraglutide and exenatide once weekly (exeOW) in type 2 diabetic (T2D) patients under routine care. METHODS This was a retrospective, multicenter, real-world study on patients with T2D (aged 18-80) initiating a GLP-1RA between 2010 and 2018 at specialist outpatient clinics. We compared the effectiveness of dulaglutide versus liraglutide and exeOW on the changes in HbA1c (primary outcome), body weight, blood pressure and fasting glucose (secondary outcomes). Average follow-up was 5.9 months. Channelling biases were addressed with propensity score matching or multivariable adjustment. Meta-analyses of observational studies, covering the same comparisons, are also presented. RESULTS 849, 1371 and 198 patients were included in the dulaglutide, liraglutide and exeOW groups, respectively. The reduction of HbA1c was greater with dulaglutide than with liraglutide (-0.24 ± 0.08%; p = 0.003), and was confirmed in the meta-analysis of observational studies. In our study, dulaglutide showed similar effectiveness compared to exeOW. When these results were pooled with other observational studies, dulaglutide showed a greater reduction of HbA1c (-0.19%; p = 0.003) and body weight (-0.8 kg; p = 0.007). CONCLUSIONS In a real-world scenario, dulaglutide reduced HbA1c more than liraglutide. Conversely, we found similar effect of dulaglutide and exeOW, with statistical differences arising solely when results were meta-analysed with those from other observational studies. Lack of up-titration for liraglutide and higher discontinuation rate for exeOW likely influenced the estimated treatment difference.

中文翻译：

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度拉鲁肽与每周一次的利拉鲁肽和艾塞那肽的有效性。现实世界研究和观察研究的荟萃分析。


简介和目的 胰高血糖素样肽 1 受体激动剂 (GLP-1RA) 之间头对头比较的真实数据很少。因此，我们的目的是比较度拉鲁肽与利拉鲁肽和艾塞那肽每周一次 (exeOW) 在常规护理下的 2 型糖尿病 (T2D) 患者中的有效性。方法 这是一项回顾性、多中心、真实世界研究，对象为 2010 年至 2018 年间在专科门诊接受 GLP-1RA 治疗的 T2D 患者（年龄 18-80 岁）。我们比较了度拉鲁肽与利拉鲁肽和 exeOW 在 HbA1c（主要结果）、体重、血压和空腹血糖（次要结果）变化方面的有效性。平均随访时间为 5.9 个月。通过倾向评分匹配或多变量调整来解决渠道偏差。还提供了涵盖相同比较的观察性研究的荟萃分析。结果度拉鲁肽组、利拉鲁肽组和 exeOW 组分别包括 849 名、1371 名和 198 名患者。度拉鲁肽的 HbA1c 降低幅度大于利拉鲁肽（-0.24 ± 0.08%；p = 0.003），这一点在观察性研究的荟萃分析中得到证实。在我们的研究中，度拉鲁肽与 exeOW 相比显示出相似的有效性。当将这些结果与其他观察性研究合并时，度拉鲁肽显示出 HbA1c（-0.19%；p = 0.003）和体重（-0.8 kg；p = 0.007）的更大降低。结论 在现实场景中，度拉鲁肽比利拉鲁肽更能降低 HbA1c。相反，我们发现度拉鲁肽和 exeOW 具有类似的效果，仅当将结果与其他观察性研究的结果进行荟萃分析时才会出现统计差异。 利拉鲁肽缺乏上调和 exeOW 较高的停药率可能影响了估计的治疗差异。