Comparison of the Efficacy of Once Weekly Dose of Trelagliptin Versus Once Daily Dose of Vildagliptin on the Levels of HbA1c in Type-2 Diabetes Patients
Trelagliptin vs Vildagliptin in Type 2 Diabetes Patients
DOI:
https://doi.org/10.54393/pjhs.v7i9.3982Keywords:
Type 2 Diabetes Mellitus, Trelagliptin, Vildagliptin, Metformin, Glycated Hemoglobin, Randomized Clinical TrialAbstract
Once-weekly dipeptidyl peptidase-4 inhibition represents a potential strategy to reduce dosing burden while maintaining glycaemic efficacy in type 2 diabetes mellitus. Objectives: To compare once-weekly trelagliptin with once-daily vildagliptin in adults receiving background metformin, using change in glycated hemoglobin and attainment of glycated hemoglobin below 7%, with secondary assessment of body weight and body mass index. Methods: A randomized, open-label, parallel-group clinical trial was conducted at a tertiary care hospital. Adults aged 30 to 60 years with type 2 diabetes mellitus, glycated hemoglobin 7.5% to 9.5% on metformin, were randomized by lottery to trelagliptin 100 mg once weekly or vildagliptin 50 mg once daily for 12 weeks. Independent-samples t testing and chi-square or Fisher's exact testing were applied as appropriate. Prespecified stratified analyses were performed for the efficacy endpoint. Results: A total of 102 participants were randomized, and 93 completed follow-ups. Baseline characteristics were comparable. Glycated hemoglobin change was −1.24±0.78% with trelagliptin and −1.52±0.67% with vildagliptin, mean difference 0.28% (95% CI −0.02 to 0.58), p=0.068. Target attainment was 53.2% versus 63.0%, p=0.336. Weight and body mass index changes did not differ significantly, and stratified analyses showed no significant subgroup effects. Conclusions: No statistically significant difference was detected between once-weekly trelagliptin and once-daily vildagliptin in glycaemic improvement over 12 weeks in patients. Short-term changes in body weight and body mass index were also not significantly different between the two treatment groups.
References
Genitsaridi I, Salpea P, Salim A, Sajjadi SF, Tomic D, James S et al. IDF Diabetes Atlas: global, regional, and national diabetes prevalence estimates for 2024 and projections for 2050. The Lancet Diabetes and Endocrinology. 2026 Feb; 14(2): 149-156. doi: 10.1016/S2213-8587(25)00299-2. DOI: https://doi.org/10.1016/S2213-8587(25)00299-2
Ali M, Alam MM, Rifat MA, Simi SM, Sarwar S, Amin MR et al. Prevalence of Diabetes and Prediabetes in South Asian Countries: A Systematic Review and Meta-Analysis. Discover Public Health. 2025 Jan; 22(1): 39. doi: 10.1186/s12982-025-00426-8. DOI: https://doi.org/10.1186/s12982-025-00426-8
Dina MA, Arshed A, Karamat A, Bilal M, Basit MS. Diabetes Mellitus in Pakistan: Prevalence and Preventive Management Strategies–A Comprehensive Literature Review. Cardiovascular Diabetology–Endocrinology Reports. 2025 Oct; 11(1): 24. doi: 10.1186/s40842-025-00235-7. DOI: https://doi.org/10.1186/s40842-025-00235-7
Salama II, Sami SM, Salama SI, Abdel-Latif GA, Aboulghate A, Raslan HM et al. Impact of Lifestyle Modification on Glycemic Control and Cognitive Function Among Type II Diabetes Mellitus Patients. Future Science OA. 2023 Jan; 9(1): 835. doi: 10.2144/fsoa-2022-0060. DOI: https://doi.org/10.2144/fsoa-2022-0060
Savage MJ, Goldney J, Slater T, Sarkar P, Sargeant JA, Wilmot EG et al. Management of Early-Onset Type 2 Diabetes in Adults: Current Evidence and Future Directions. Diabetes and Metabolism Journal. 2025 Sep; 49(5): 934-950. doi: 10.4093/dmj.2025.0561. DOI: https://doi.org/10.4093/dmj.2025.0561
ElSayed NA, McCoy RG, Aleppo G, Bajaj M, Balapattabi K, Beverly EA et al. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025. Diabetes Care. 2025 Jan; 48: S181. doi: 10.2337/dc25-S009. DOI: https://doi.org/10.2337/dc25-S009
Padhi S, Nayak AK, Behera A. Type II Diabetes Mellitus: A Review on Recent Drug-Based Therapeutics. Biomedicine and Pharmacotherapy. 2020 Nov; 131: 110708. doi: 10.1016/j.biopha.2020.110708. DOI: https://doi.org/10.1016/j.biopha.2020.110708
Evans M, Engberg S, Faurby M, Fernandes JD, Hudson P, Polonsky W. Adherence to and Persistence with Antidiabetic Medications and Associations with Clinical and Economic Outcomes in People with Type 2 Diabetes Mellitus: A Systematic Literature Review. Diabetes, Obesity and Metabolism. 2022 Mar; 24(3): 377-90. doi: 10.1111/dom.14603. DOI: https://doi.org/10.1111/dom.14603
Naim MJ. A Review of Dipeptidyl Peptidase-4 (DPP-4) and Its Potential Synthetic Derivatives in the Management of Diabetes Mellitus. Journal of Angiotherapy. 2024 Jan; 8(1): 1-2. doi: 10.25163/angiotherapy.819417. DOI: https://doi.org/10.25163/angiotherapy.819417
Saini K, Sharma S, Khan Y. DPP-4 Inhibitors for Treating T2DM-Hype or Hope? An Analysis Based on the Current Literature. Frontiers in Molecular Biosciences. 2023 May; 10: 1130625. doi: 10.3389/fmolb.2023.1130625. DOI: https://doi.org/10.3389/fmolb.2023.1130625
Nazeer A, Khan JA, Younus MI. Comparison of Efficacy of Once-Weekly Trelagliptin versus Once-Daily Vildagliptin on Glycemic Control in Patients with Type 2 Diabetes: A Randomized Controlled Trial. Indus Journal of Bioscience Research. 2025 Jul; 3(7): 362-365. doi: 10.70749/ijbr.v3i7.1936. DOI: https://doi.org/10.70749/ijbr.v3i7.1936
Inagaki N, Sano H, Seki Y, Kuroda S, Kaku K. Efficacy and Safety of Once‐Weekly Oral Trelagliptin Switched from Once‐Daily Dipeptidyl Peptidase‐4 Inhibitor in Patients with Type 2 Diabetes Mellitus: An Open‐Label, Phase 3 Exploratory Study. Journal of Diabetes Investigation. 2018 Mar; 9(2): 354-359. doi: 10.1111/jdi.12730. DOI: https://doi.org/10.1111/jdi.12730
Meguro S, Matsui S, Itoh H. Treatment Preference for Weekly Versus Daily DPP-4 Inhibitors in Patients with Type 2 Diabetes Mellitus: Outcomes from the TRINITY trial. Current Medical Research and Opinion. 2019 Dec; 35(12): 2071-2078. doi: 10.1080/03007995.2019.1651130. DOI: https://doi.org/10.1080/03007995.2019.1651130
Dutta D, Mohindra R, Surana V, Sharma M. Safety and Efficacy of Once Weekly Dipeptidyl-Peptidase-4 Inhibitor Trelagliptin in Type-2 Diabetes: A Meta-Analysis. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2022 Apr; 16(4): 102469. doi: 10.1016/j.dsx.2022.102469. DOI: https://doi.org/10.1016/j.dsx.2022.102469
Dewan B, Shinde S, Roy S. Efficacy and Safety of Once-Weekly Trelagliptin as Compared to Twice-Daily Vildagliptin in Indian Patients with Type 2 Diabetes Mellitus: A Randomized, Phase 3, Non-inferiority Clinical Trial. Cureus. 2025 Jun; 17(6). doi: 10.7759/cureus.85219. DOI: https://doi.org/10.7759/cureus.85219
Inagaki N, Onouchi H, Maezawa H, Kuroda S, Kaku K. Once-Weekly Trelagliptin Versus Daily Alogliptin in Japanese Patients with Type 2 Diabetes: A Randomised, Double-Blind, Phase 3, Non-Inferiority Study. The Lancet Diabetes and Endocrinology. 2015 Mar; 3(3): 191-197. doi: 10.1016/S2213-8587(14)70251-7. DOI: https://doi.org/10.1016/S2213-8587(14)70251-7
Grimshaw CE, Jennings A, Kamran R, Ueno H, Nishigaki N, Kosaka T et al. Trelagliptin (SYR-472, Zafatek), Novel Once-Weekly Treatment for Type 2 Diabetes, Inhibits Dipeptidyl Peptidase-4 (DPP-4) Via A Non-Covalent Mechanism. PLoS One. 2016 Jun; 11(6): 157509. doi: 10.1371/journal.pone.0157509. DOI: https://doi.org/10.1371/journal.pone.0157509
Wu C, Liu H, Yu S, Ren C, Zhang J, Wang G et al. Prediction of Pharmacokinetics and Pharmacodynamics of Trelagliptin and Omarigliptin in Healthy Humans and in Patients with Renal Impairment Using Physiologically Based Pharmacokinetic Combined DPP-4 Occupancy Modeling. Biomedicine and Pharmacotherapy. 2022 Sep; 153: 113509. doi: 10.1016/j.biopha.2022.113509. DOI: https://doi.org/10.1016/j.biopha.2022.113509
Chai S, Zhang R, Zhang Y, Carr RD, Zheng Y, Rajpathak S et al. Influence of Dipeptidyl Peptidase-4 Inhibitors on Glycemic Variability in Patients with Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Endocrinology. 2022 Aug; 13: 935039. doi: 10.3389/fendo.2022.935039. DOI: https://doi.org/10.3389/fendo.2022.935039
Ishii H, Suzaki Y, Miyata Y, Matsui S. Randomized multicenter evaluation of quality of life and treatment satisfaction in type 2 diabetes patients receiving once-weekly trelagliptin versus a daily dipeptidyl peptidase-4 inhibitor. Diabetes Therapy. 2019 Aug; 10(4): 1369-80. doi: 10.1007/s13300-019-0643-1. DOI: https://doi.org/10.1007/s13300-019-0643-1
Suzuki K, Hasegawa K, Watanabe M. Efficacy and patient satisfaction of dipeptidyl peptidase-4 inhibitor after switching from once-daily DPP-4 inhibitor to once-weekly regimen. Journal of Clinical Medicine Research. 2018 Jun; 10(8): 641. doi: 10.14740/jocmr3456w. DOI: https://doi.org/10.14740/jocmr3456w
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments



