Indirect comparison of clinical efficacy between dapagliflozin and acarbose in type 2 diabetes mellitus: a systematic review and Meta-analysis

Objective To compare the clinical efficacy between dapagliflozin and acarbose in type 2 diabetes mellitus (T2DM) by systematic review and Meta-analysis. Methods Eligible randomized controlled trials were searched to compare dapagliflozin or acarbose monotherapy with placebo from PubMed, the Cochrane Library, Web of Science, CNKI Database, Wan Fang Database and VIP Database until 30 April 2016. Meta-analysis were conducted to evaluate the levels of HbA1c, body weight and systolic blood pressure (SBP) after treatment of dapagliflozin, acarbose and placebo. Bucher method was applied to convert the summary estimates from Meta-analysis into weighted-mean-difference (WMD). Results A total of 21 studies were included in the Meta-analysis. HbA1c, body weight and SBP decreased 0.59% [95%CI:(-0.67, -0.51)%, P 0.05] respectively in acarbose monotherapy than those in placebo therapy. By indirect comparison using placebo as a common comparator, HbA1c decreased 0.07% in dapagliflozin monotherapy than that in acarbose monotherapy, but the difference wasn′t significant [(-0.21, 0.07)%, P=0.341]; Additionally, body weight and SBP decreased 0.92[(-1.37, -0.47) kg, P<0.001] and 2.47[(-4.91, -0.03) mmHg, P<0.05] respectively in dapagliflozin monotherapy than those in acarbose monotherapy. Conclusions The monotherapy efficacy of dapagliflozin in HbA1c reduction is similar to that of acarbose, but the monotherapy effects of dapagliflozin in weight loss and SBP reduction are better than those of acarbose. Key words: Diabetes mellitus, type 2; Meta-analysis; Dapagliflozin; Acarbose