Systematic Reviews/Meta-Analysis
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Background:
Numerous glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been used in children and adolescents with obesity or overweight plus diabetes. However, it remains unclear which GLP-1 RAs are the most effective and safe.
Methods: We searched PubMed, Scopus, and Embase up to March 10, 2023. Randomized controlled trials (RCTs) comparing the effects of GLP-1 RAs to placebo or other treatments in children and adolescents with obesity or overweight plus type 2 diabetes were included. The primary efficacy outcomes were mean changes in weight, waist circumference, BMI, and BMI z score. Safety outcomes included the incidence of nausea, vomiting, diarrhea, abdominal pain, and hypoglycemia. Cochrane Collaboration’s tool for randomized trials assessed the risk of bias. Mean differences (MDs) and 95% credible intervals (CIs) were reported. Different treatments were ranked using the surface under the cumulative ranking (SUCRA) probabilities.
Results: Eleven RCTs enrolling 953 participants (mean age 14.7 years; 38% male; baseline weight 100 kg, and BMI 35.8 kg/m2) were eligible, evaluating the effects of semaglutide, dulaglutide, liraglutide, and exenatide. Eight studies included obese patients, while three enrolled overweight adolescents with type 2 diabetes. Semaglutide showed the greatest reductions in weight (MD -17.67 kg, 95% CI -23.18 to -12.37), BMI (MD -5.99 kg/m2, 95% CI -9.36 to -2.72), and BMI z score (MD -1.00, 95% CI -1.54 to -0.46) versus placebo. SUCRA values indicated that semaglutide was more effective than other GLP-1 RAs (weight 99.9%; waist circumference 93.0%; BMI 98.0%; BMI z score 98.9%). Safety of liraglutide was the poorest among all GLP-1 RAs (nausea 76.8%; vomiting 66.4%; diarrhea 81.5%; hypoglycemia 73%; abdominal pain 73.5%).
Discussion: Current evidence suggests that semaglutide appears to be the most effective and safe pharmacotherapy option among four GLP-1 RAs in children and adolescents with obesity or overweight plus diabetes. Direct comparative studies between different GLP-1 RAs are needed.
Other: None
Presenting Author
Ligang Liu PharmDUse login from my institution
Authors
Nuojin Guo MD
Fudan University
Milap C. Nahata PharmD, MS
The Ohio State University College of Pharmacy
Heqing Tao MD
Department of Gastroenterology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University
Anlin Wang PharmD
Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University
Hekai Shi MD
Department of Thoracic Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China
Yufei Shi PharmD
Fudan University