Insulin Efsitora Demonstrates Similar Efficacy and Safety Profiles to Insulin Icodec in Insulin-Experienced Individuals With Type 2 Diabetes Mellitus: Matching-Adjusted Indirect Comparisons of QWINT-3 Versus ONWARDS 2, and QWINT-4 Versus ONWARDS 4.
Harpreet S Bajaj, Marvin Fischer, Michael B Davidson et al.
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In 30 seconds
This matching-adjusted indirect treatment comparison assessed once-weekly insulin efsitora versus insulin icodec in insulin-experienced adults with type 2 diabetes, using data from the randomised QWINT-3 and ONWARDS 2 trials and QWINT-4 and ONWARDS 4 trials. Among basal-insulin-experienced participants, HbA1c change was comparable, while efsitora was associated with less weight gain (mean difference -1.52 kg [-2.60, -0.447]) and a lower event rate of Level 2 or 3 hypoglycaemia (rate ratio 0.436 [0.241, 0.786]). In basal-bolus-experienced participants, the compared outcomes were similar between treatments.
Key findings
- For basal-insulin-experienced participants, HbA1c change was comparable between efsitora and icodec (mean difference 0.137 [-0.058, 0.333]).
- Efsitora was associated with less weight gain than icodec in basal-insulin-experienced participants (mean difference -1.52 kg [-2.60, -0.447]).
- The Level 2 or 3 hypoglycaemia event rate was lower with efsitora in basal-insulin-experienced participants (rate ratio 0.436 [0.241, 0.786]), although the proportion experiencing events did not differ significantly.
- In basal-bolus-experienced participants, HbA1c, body weight, and Level 2 or 3 hypoglycaemia outcomes were comparable between treatments.
Why it matters
Weekly basal insulin options are being compared in people already using insulin, and the findings suggest that treatment differences may depend on prior insulin regimen. The lower hypoglycaemia event rate and less weight gain observed with efsitora in basal-insulin-experienced participants may inform interpretation of comparative benefits, while the indirect design means these results are not equivalent to a direct head-to-head trial.
What to keep in mind
The comparisons were indirect and relied on matching-adjusted analyses of separate trials, rather than a direct randomised comparison of efsitora and icodec.