Combinations of insulin glargine/lixisenatide (IGlarLixi) or insulin degludec/insulin aspart (IDegAsp) are considered treatment intensification in type 2 diabetes mellitus upon limited response to basal insulin. In the absence of head-to-head trials comparing the efficacy of IGlarLixi and IDegAsp, a meta-analysis based on phase III trials was conducted.
Two phase III trials (BOOST and LIXILAN) were included in this meta-analysis, with 366 eligible patients on IGlarLixi and 230 eligible patients on IDegAsp. Treatments were primarily compared in terms of estimated treatment difference (ETD) in glycated haemoglobin (HbA1c) change from baseline; in addition to changes in fasting and prandial plasma glucose (FPG and PPG), and self-monitoring blood glucose (SMBG) score changes. Hypoglycaemia incidence and weight changes were described.
In a fixed-effect model controlling for HbA1c, and compared with IDegAsp, IGlarLixi was more effective at reducing levels of HbA1c (ETD 0.53% [95%CI 0.27;-0.79, P<0.0001]), PPG (ETD 2.65% [95%CI 1.96;3.34], P<0.0001), and body weight (ETD 1.73 kg [95%CI 1.09;2.47], P<0.0001). A higher proportion of patients on IGlarLixi achieved glycemic control (ETD 0.40 [95%CI -0.083;0.884], P<0.0001). FPG and SMBG changes were not significantly different between treatment groups.
Patients on IGlarLixi were also more likely to achieve HbA1c<7% than patients on IDegAsp (odds ratio [OR]=0.401 [95%CI -0.083;0.884], P<0.0001), with lower overall incidence of hypoglycaemia (OR=1.328 [95%CI 0.859;1.797], P<0.001).
In this trial meta-analysis, IGlarLixi seemed to be more efficient than IDegAsp in controlling HbA1c and PPG and was associated with greater weight loss and lower incidence of hypoglycaemia.