Real-World Efficacy of Gliclazide Modified Release vs Sitagliptin in Uncontrolled T2D

Sarfaroj Khan 

August 13, 2020

Takeaway

  • Gliclazide modified release (MR) as second-line type 2 diabetes (T2D) treatment after optimal metformin monotherapy is more effective than sitagliptin in reducing glycated haemoglobin (HbA1c), with similar durability and persistence and numerically higher but with low rates of hypoglycaemia, according to a retrospective, real-world study.

Why this matters

  • Findings provide evidence that gliclazide MR plays an important role in clinical practice, and further investigations on dose, other safety outcomes and patient weight are warranted to evaluate the entire risk-benefit profile of this drug.

Study design

  • A retrospective cohort study of patients with T2D (HbA1c, ≥7.0%) newly treated with either gliclazide MR (n=1207) or sitagliptin (n=5479) as an add-on to metformin using data from the UK Clinical Practice Research Datalink (CPRD).

  • Patients were 1:1 matched using high-dimensional propensity score matching and followed to determine the time taken to reach an HbA1c <7.0%.

  • Funding: Servier.

Key results

  • Patients treated with gliclazide MR vs those treated with sitagliptin were more likely to achieve the target of:

    • HbA1c <7.0% (HR, 1.35; 95% CI, 1.15-1.57);

    • HbA1c ≤6.5% (HR, 1.51; 95% CI, 1.19-1.92); and

    • HbA1c reduction of ≥1% from baseline (HR, 1.11; 95% CI, 1.00-1.24).

  • Median treatment durability (2.6 and 2.5 years; log-rank P=.135) and persistence (2.7 and 2.5 years; P=.119) did not differ between the gliclazide MR and sitagliptin groups, respectively.

  • Overall, few severe and non-severe hypoglycaemic episodes occurred (23 severe and non-severe events; incidence rate, 3.7 events per 1000 patient-years), with 4.7 and 2.6 events per 1000 patient-years with gliclazide MR and sitagliptin treatment, respectively.

Limitations

  • Retrospective design.

View abstract 

Zaccardi F, Jacquot E, Cortese V, Tyrer F, Seidu S, Davies MJ, Khunti K. Comparative effectiveness of gliclazide modified release vs sitagliptin as second-line treatment after metformin monotherapy in patients with uncontrolled type 2 diabetes. Diabetes Obes Metab. 2020 Aug 5 [Epub ahead of print]. doi: 10.1111/dom.14169. PMID: 32761768

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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