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Systematic Literature review and Network Meta-Analysis (NMA) of Ertugliflozin 5mg Compared to other SGLT-2 inhibitors Commonly Prescribed in the Republic of Korea (ROK) among Patients with Type 2 Diabetes Mellitus (T2DM) Uncontrolled on Metformin
( Ann Marie Mcneill ) , ( Glenn Davies ) , ( Eliza Kruger ) , ( Tim Reason ) , ( Flavia Ejzykowicz ) , ( Hakima Hannachi ) , ( Nilo Cater ) , ( Euan Mcleod )
UCI I410-ECN-0102-2021-500-000099457
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Objective: Indirect comparisons of the efficacy and safety of ertugliflozin from VERTIS MET and FACTORIAL trials to other SGLT-2 inhibitors have been conducted. As SGLT-2 inhibitors available in ROK differ from those previously presented, the objective of this analysis was to present findings focused on indirect comparison of ertugliflozin 5 mg to other SGLT-2 inhibitors at doses commonly prescribed in ROK. Methods: A systematic literature review was conducted in multiple databases (Pubmed, EMBASE, Cochrane) until end 2016 for RCTs of 24~26 weeks duration in T2DM patients with uncontrolled A1C on metformin only. Relevant comparators to ertugliflozin 5 mg in ROK were dapagliflozin 10mg, empagliflozin 10 mg and 25 mg. Included outcomes vs placebo at 24~26 weeks were change in A1C, weight, and systolic blood pressure; A1C < 7% and safety outcomes (urinary tract infections, genital mycotic infections [GMI], hypoglycemic events and patients with ≥ 1 adverse event). Evidence synthesis used both fixed effect and random effects Bayesian NMA, with model selection informed by guidelines. 95% credible intervals (CrI) were used to determine significance. Results: The NMA included 7 RCTs. For change in A1C there were no significant differences: ertugliflozin 5mg was comparable to dapagliflozin 10mg (mean difference [MD]: -0.14%, CrI -0.34, 0.06); empagliflozin 10mg (MD: -0.14%, Crl -0.34 to 0.07); and empagliflozin 25mg (MD: -0.11%, Crl -0.32 to 0.09). Ertugliflozin 5 mg was also comparable to dapagliflozin and empagliflozin for other efficacy and safety outcomes with the exception of hypoglycemia and GMI, where limited numbers of events prevented robust comparisons. Impact of heterogeneity was evaluated in sensitivity analyses, however potential confounding due to differences in factors such as study design and patient population may remain. Conclusion: Although reliant upon indirect comparison rather than head-tohead RCTs, this analysis found no differences between ertugliflozin 5 mg and either dapagliflozin or empagliflozin across a range of efficacy and safety outcomes.

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