Patient preference and tolerability of a DPP-4 inhibitor versus a GLP-1 analog in patients with type 2 diabetes mellitus inadequately controlled with metformin: a 24-week, randomized, multicenter, crossover study

Abstract

Objective: The present study aimed to assess the patient preference and tolerability of oral dipeptidyl peptidase-4 inhibitor (vildagliptin) versus injectable glucagon-like peptide-1 analog (liraglutide) in patients with type 2 diabetes mellitus inadequately controlled with metformin monotherapy.

Methods: This 24-week, randomized, multicenter, crossover study, patients with type 2 diabetes mellitus inadequately controlled on metformin monotherapy with hemoglobin A1c (HbA1c) ⩾6.5% and ⩽9.0% were randomized in a crossover manner to receive either vildagliptin/metformin single-pill combination (SPC) 50/1000 mg twice daily (n = 32) or 1.2 mg liraglutide as an add-on to metformin (0.6 mg [weeks 0-1] followed by 1.2 mg [weeks 2-12] once daily/1000 mg twice daily) (n = 30) for the first 12 weeks.

Results: Patient preference at week 24 was similar, with 51.7% (n = 31) patients preferring vildagliptin/metformin SPC compared with 48.3% (n = 29) preferring liraglutide as an add-on to metformin therapy (p = 0.449). Post hoc analyses showed that more elderly patients (⩾65 years) preferred vildagliptin (65%; n = 13) over liraglutide (35%; n = 7) therapy. Liraglutide was associated with better improvement in fasting plasma glucose (-21.5 mg/dl versus -3.4 mg/dl) and HbA1c (-0.5% versus -0.3%) levels. Fewer adverse events were reported with vildagliptin/metformin SPC (n = 16) compared with liraglutide as add-on to metformin treatment (n = 46).

Conclusions: In this pilot study, although both vildagliptin and liraglutide therapies were preferred similarly by the patients and showed effective control of glycemia over 12 weeks, vildagliptin was associated with fewer adverse events and was preferred more by elderly patients.

Keywords: dipeptidyl peptidase-4 inhibitor; glucagon-like peptide-1 analog; liraglutide; medication preference; type 2 diabetes mellitus; vildagliptin.

Conflict of interest statement

Declaration of Conflicting Interests: JL has received fees for consultancy advisory boards, education talks, and speaker fees from AstraZeneca, Bayer, Bristol-Myers Squibb, Eli Lilly & Co., Merck Sharp & Dohme, Novartis, Novo Nordisk, and Sanofi, outside the submitted work. ED and MD are employees of Novartis Pharma GmBH and as such may be eligible for the company’s stock and stock-options, outside the submitted work.

Figures

Figure 1.

Study design. TC, telephone contact; V, visit; bid, twice daily; qd, once daily.

Figure 2.

Patient preference for treatment at week 24. ^p = 0.449/ *Efficacy set consisted of all patients who completed the patient preference questionnaire at the end of the study (N = 60). **Safety set consisted of all patients who received at least one dose of the study medication during at least one study period and had at least one safety assessment after baseline.

Figure 3.

Physician preference for treatment at week 24. *Efficacy set consisted of all patients who completed the patient preference questionnaire at the end of the study (N = 60).