第一代胰島素類似物
First-Generation Basal Insulin Analogs: Insulin Glargine 100 Units/mL and Insulin Detemir
第二代胰島素類似物
Second-Generation Basal Insulin Analogs: Insulin Glargine 300 Units/mL and Insulin Degludec 100 Units/mL and 200 Units/mL
第二代胰島素類似物明顯優於第一代
IDeg insulin degludec
IDet insulin detemir
Gla-100 insulin glargine 100 units/mL
Gla-300 insulin glargine 300 units/mL
將很多篇研究進行分析比較,
第一篇說 , 在T1DM病患, Gla-300 低劑量(0.4u/Kg)的藥效較穩定, 高劑量沒差異
但控糖效果比 IDeg-100 差, 低血糖機率高於 IDeg
第二第三篇研究提供的是間接比較
第四篇 DELIVER D+ study, 在 T2DM病患使用 Gla-300 與 IDeg-100, 比較後發現, 兩者控糖效果和低血糖機率相近
第五篇 LIGHTNING study發現, Gla-300 or IDeg 嚴重低血糖機率較 Gla-100 or IDet 低
第六篇 the CONFIRM real-world analysis發現, IDeg 優於 Gla-300, 低血糖較少, 控糖效果較好
第七篇The BRIGHT study發現, 在T2DM患者, 使用 Gla-300 的前期, 低血糖機率較 IDeg-100 低, 但最後兩者控糖效果相似, 整體低血糖機率相似,
Gla-300 比 IDeg-100, 低劑量使用時 (0.4u/kg/day)藥效更穩定, 分布較均勻, 但在較高劑量時沒有差異 (0.6u/kg/day).
從其他基礎胰島素換成 Gla-300 或 IDeg-100, 血糖控制結果相似, 低血糖發生率相似
CONFIRM real-world analysis 顯示, IDeg-100 與 Gla-300 比較, 血糖控制較佳, 低血糖機率較低, insulin retention 較佳. 但 real-world analysis 無法做到隨機分配, 仍需更多隨機研究證實
The BRIGHT study 比較 Gla-300 與 IDeg-100, 血糖控制結果相近, 整體低血糖機率相近, 但在研究開始的前一半時間內, 為降低血糖增加胰島素劑量時, Gla-300 低血糖機率較低
在調整胰島素劑量期間, Gla-300 發生低血糖的機率較 IDeg-100 低
Second-Generation Basal Insulin Analogs Compared with Each Other
The benefits of second-generation basal insulin analogs over first-generation are well established. Currently, comparison within class is clinically meaningful and such comparisons are emerging.
Gla-300 與 IDeg-100 比較
In a study that compared steady-state PK and PD profiles of Gla-300 and IDeg-100 in patients with T1D, Gla-300 provided a steadier PD profile (20% lower within-day fluctuation in GIR) and a more evenly distributed PK profile (Fig. 6) at a 0.4 units/kg/day dose; however, no significant differences were seen at the higher 0.6 units/kg/day dose [10].
A trial-level meta-analysis of the EDITION and BEGIN programs offered indirect comparison [45]. In the DELIVER D+ study, a direct comparison of real-world clinical outcomes with Gla-300 and IDeg showed that people with T2D switching from other basal insulins to two second-generation basal insulin analogs had comparable glycemic control, and incidence and rates of hypoglycemia [42].
Real-world analysis of electronic health records in the LIGHTNING study also demonstrated similar levels of glycemic control across basal insulins, but reported significantly lower rates of severe hypoglycemia in patients switching to Gla-300 or IDeg, compared with Gla-100 or IDet [46].
Among insulin-naïve patients with T2D, the CONFIRM real-world analysis showed that the group receiving IDeg had less hypoglycemia, greater glycemic control, and improved insulin retention compared with Gla-300 [47]. However, there are limitations to real-world observational analyses, with randomized controlled clinical trials needed to better understand differences between therapies.
The BRIGHT study is the first head-to-head randomized controlled trial comparing Gla-300 with IDeg in insulin-naïve patients with T2D. The study demonstrated comparable levels of glycemic control with similar overall incidence and rates of hypoglycemia. However, hypoglycemia was lower with Gla-300 during the first half of the study (titration period) when the greatest glucose reduction and insulin dose increase occurred.
Gla-100 insulin glargine 100 units/mL
Gla-300 insulin glargine 300 units/mL
將很多篇研究進行分析比較,
第一篇說 , 在T1DM病患, Gla-300 低劑量(0.4u/Kg)的藥效較穩定, 高劑量沒差異
但控糖效果比 IDeg-100 差, 低血糖機率高於 IDeg
第二第三篇研究提供的是間接比較
第四篇 DELIVER D+ study, 在 T2DM病患使用 Gla-300 與 IDeg-100, 比較後發現, 兩者控糖效果和低血糖機率相近
第五篇 LIGHTNING study發現, Gla-300 or IDeg 嚴重低血糖機率較 Gla-100 or IDet 低
第六篇 the CONFIRM real-world analysis發現, IDeg 優於 Gla-300, 低血糖較少, 控糖效果較好
第七篇The BRIGHT study發現, 在T2DM患者, 使用 Gla-300 的前期, 低血糖機率較 IDeg-100 低, 但最後兩者控糖效果相似, 整體低血糖機率相似,
Gla-300 比 IDeg-100, 低劑量使用時 (0.4u/kg/day)藥效更穩定, 分布較均勻, 但在較高劑量時沒有差異 (0.6u/kg/day).
從其他基礎胰島素換成 Gla-300 或 IDeg-100, 血糖控制結果相似, 低血糖發生率相似
CONFIRM real-world analysis 顯示, IDeg-100 與 Gla-300 比較, 血糖控制較佳, 低血糖機率較低, insulin retention 較佳. 但 real-world analysis 無法做到隨機分配, 仍需更多隨機研究證實
The BRIGHT study 比較 Gla-300 與 IDeg-100, 血糖控制結果相近, 整體低血糖機率相近, 但在研究開始的前一半時間內, 為降低血糖增加胰島素劑量時, Gla-300 低血糖機率較低
在調整胰島素劑量期間, Gla-300 發生低血糖的機率較 IDeg-100 低
Second-Generation Basal Insulin Analogs Compared with Each Other
The benefits of second-generation basal insulin analogs over first-generation are well established. Currently, comparison within class is clinically meaningful and such comparisons are emerging.
Gla-300 與 IDeg-100 比較
In a study that compared steady-state PK and PD profiles of Gla-300 and IDeg-100 in patients with T1D, Gla-300 provided a steadier PD profile (20% lower within-day fluctuation in GIR) and a more evenly distributed PK profile (Fig. 6) at a 0.4 units/kg/day dose; however, no significant differences were seen at the higher 0.6 units/kg/day dose [10].
A trial-level meta-analysis of the EDITION and BEGIN programs offered indirect comparison [45]. In the DELIVER D+ study, a direct comparison of real-world clinical outcomes with Gla-300 and IDeg showed that people with T2D switching from other basal insulins to two second-generation basal insulin analogs had comparable glycemic control, and incidence and rates of hypoglycemia [42].
Real-world analysis of electronic health records in the LIGHTNING study also demonstrated similar levels of glycemic control across basal insulins, but reported significantly lower rates of severe hypoglycemia in patients switching to Gla-300 or IDeg, compared with Gla-100 or IDet [46].
Among insulin-naïve patients with T2D, the CONFIRM real-world analysis showed that the group receiving IDeg had less hypoglycemia, greater glycemic control, and improved insulin retention compared with Gla-300 [47]. However, there are limitations to real-world observational analyses, with randomized controlled clinical trials needed to better understand differences between therapies.
The BRIGHT study is the first head-to-head randomized controlled trial comparing Gla-300 with IDeg in insulin-naïve patients with T2D. The study demonstrated comparable levels of glycemic control with similar overall incidence and rates of hypoglycemia. However, hypoglycemia was lower with Gla-300 during the first half of the study (titration period) when the greatest glucose reduction and insulin dose increase occurred.
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