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Introduction <p>For people with type&#xa0;2 diabetes (T2D), combination therapy with a basal insulin and a glucagon-like peptide&#xa0;1 receptor agonist (GLP-1&#xa0;RA) can improve glycaemic control, lower hypoglycaemia risk, and improve adherence. IcoSema is the first once-weekly combination of basal insulin and GLP-1&#xa0;RA in a single injection. To compare once-weekly IcoSema and once-daily IDegLira for the management of T2D in the absence of head-to-head trials, we performed a network meta-analysis (NMA).</p> Methods <p>A systematic literature review was conducted in November 2023, updated in August 2025, to identify randomised controlled trials (RCTs) of people with T2D, investigating basal insulin and GLP-1&#xa0;RA combination therapies. Data were extracted for change from baseline in glycated haemoglobin (HbA<sub>1c</sub>), body weight, systolic blood pressure, end-of-treatment basal insulin dose, rate ratio (RR) of clinically significant or severe hypoglycaemia and discontinuation due to adverse events (DDAEs). The NMA scope included multinational RCTs with evidence at 52 ± 4&#xa0;weeks. Fixed and random effects Bayesian NMAs were fitted.</p> Results <p>At 52&#xa0;weeks, compared with IDegLira, IcoSema was associated with significantly greater HbA<sub>1c</sub> reduction (− 0.4%; 95% credible interval [CrI] − 0.56, − 0.24), significantly greater body weight reduction (− 3.2&#xa0;kg; 95%&#xa0;CrI − 3.91, − 2.5), significantly lower daily insulin dose (− 9&#xa0;units/day; 95% CrI − 13, − 5) and significantly lower rates of clinically significant or severe hypoglycaemia (RR 0.35; 95% CrI 0.26, 0.46). There was no difference in the odds of DDAEs. No 52 ± 4-week IGlarLixi trials were identified.</p> Conclusion <p>These results indicate that once-weekly IcoSema is an efficacious treatment option for adults with T2D requiring insulin intensification. IcoSema was associated with improved glycaemic control, weight reduction, and lower hypoglycaemia risk compared with once-daily IDegLira, as well as a reduction in insulin and injection requirements. Weekly IcoSema offers the potential to reduce treatment burden and increase adherence, thereby improving long-term disease control and patient outcomes.</p>

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Efficacy and Safety of Once-Weekly IcoSema Versus Once-Daily IDegLira in People with Type 2 Diabetes: Systematic Literature Review and Network Meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月28日

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  • Saikrishna Kandalam,
  • Malik Benamar,
  • Corinne Le Reun,
  • Lauren Rengger,
  • Palvi Gupta,
  • Sunita Nair

摘要

Introduction

For people with type 2 diabetes (T2D), combination therapy with a basal insulin and a glucagon-like peptide 1 receptor agonist (GLP-1 RA) can improve glycaemic control, lower hypoglycaemia risk, and improve adherence. IcoSema is the first once-weekly combination of basal insulin and GLP-1 RA in a single injection. To compare once-weekly IcoSema and once-daily IDegLira for the management of T2D in the absence of head-to-head trials, we performed a network meta-analysis (NMA).

Methods

A systematic literature review was conducted in November 2023, updated in August 2025, to identify randomised controlled trials (RCTs) of people with T2D, investigating basal insulin and GLP-1 RA combination therapies. Data were extracted for change from baseline in glycated haemoglobin (HbA1c), body weight, systolic blood pressure, end-of-treatment basal insulin dose, rate ratio (RR) of clinically significant or severe hypoglycaemia and discontinuation due to adverse events (DDAEs). The NMA scope included multinational RCTs with evidence at 52 ± 4 weeks. Fixed and random effects Bayesian NMAs were fitted.

Results

At 52 weeks, compared with IDegLira, IcoSema was associated with significantly greater HbA1c reduction (− 0.4%; 95% credible interval [CrI] − 0.56, − 0.24), significantly greater body weight reduction (− 3.2 kg; 95% CrI − 3.91, − 2.5), significantly lower daily insulin dose (− 9 units/day; 95% CrI − 13, − 5) and significantly lower rates of clinically significant or severe hypoglycaemia (RR 0.35; 95% CrI 0.26, 0.46). There was no difference in the odds of DDAEs. No 52 ± 4-week IGlarLixi trials were identified.

Conclusion

These results indicate that once-weekly IcoSema is an efficacious treatment option for adults with T2D requiring insulin intensification. IcoSema was associated with improved glycaemic control, weight reduction, and lower hypoglycaemia risk compared with once-daily IDegLira, as well as a reduction in insulin and injection requirements. Weekly IcoSema offers the potential to reduce treatment burden and increase adherence, thereby improving long-term disease control and patient outcomes.