1880-LB: Efficacy and Safety of iGlarLixi vs. IDegAsp in Non-Asian People with Type 2 Diabetes Inadequately Controlled with Basal Insulin—A Systemic Literature Review and Network Meta-analysis

Introduction and Objective: The objective of this systematic review and network meta-analysis (NMA) was to estimate the relative treatment effect of iGlarLixi (insulin glargine 100 U/mL + lixisenatide) versus premixed insulin IDegAsp (insulin degludec + insulin aspart) in people with T2D inadequately controlled with basal insulin (BI).

Methods: A systematic review identified recently published randomized controlled trials (RCTs) by searching Embase (including congress abstracts from 2021-2023), MEDLINE, and CENTRAL in October 2023. Outcomes from RCTs for non-Asian people with T2D previously treated with BI who switched to iGlarLixi or IDegAsp were compared using an NMA. Differences in the definitions of hypoglycemia used in the included RCTs preclude secure comparisons. Data analysis was performed using R, version 4.0.2.

Results: Four RCTs were included (N=2535). iGlarLixi (n=810) demonstrated a significant reduction in HbA_1c vs IDegAsp (n=454) (−0.39; 95% credible interval [CrI] −0.58, −0.21 %-points). The chance of achieving HbA_1c <7.0% was 42% greater with iGlarLixi (risk ratio: 1.42; 95% CrI 1.18, 1.71). iGlarLixi resulted in a significant reduction in post-prandial glucose (PPG). Weight gain and insulin dose were significantly lower with iGlarLixi vs IDegAsp with mean differences of −1.5 (95% CrI −2.3, −0.8) kg and −5.1 (95% CrI: −8.5, −1.7) U/day. The reported event rate of documented hypoglycemia (<54-56 mg/dL) was 35% lower for iGlarLixi vs IDegAsp (event rate ratio 0.65; 95% CrI 0.46, 0.89).

Conclusion: Treatment with iGlarLixi versus premix IDegAsp was associated with a greater reduction in HbA_1c, PPG, and morning and afternoon SMPG, with less weight gain and lower insulin dose.