Comparative efficacy and safety of dipeptidyl peptidase‐4 inhibitors in adults with type 2 diabetes mellitus: A network meta‐analysis

AIMS: We have compiled updated evidence on the benefits and drawbacks of dipeptidyl peptidase-4 (DPP-4) inhibitors in treating type 2 diabetes mellitus. MATERIALS AND METHODS: We systematically searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov (as of 20 May 2024). Effect estimates were calculated using network meta-analysis under the frequentist framework. The P-score established the ranking of competing treatments. RESULTS: The authors incorporated 58 studies containing data from a substantial sample size of 21 332 patients. Based on evidence of high and moderate certainty, respectively, teneligliptin and vildagliptin were found to be superior to all other DPP-4 inhibitors in lowering haemoglobin A1c (mean difference [MD] -0.81%, 95% CI -1.03, -0.60) and fasting blood glucose (MD -1.18 mmol/L, 95% CI -1.56, -0.81) compared to placebo. The absence of conclusive differences between interventions for serious adverse events was supported by evidence, which was interpreted with low to very low certainty. CONCLUSIONS: In adults with type 2 diabetes, teneligliptin was most effective for HbA1c control, and vildagliptin for fasting blood glucose. No significant differences in serious adverse events were noted among DPP-4 inhibitors compared to placebo. Given the therapeutic significance of these findings, more studies are needed to explore this issue more thoroughly.