Once-Weekly Insulin Efsitora Alfa Versus Once Daily Insulin in Patients With Type 2 Diabetes: A Systematic Review and...

Once-daily basal insulin is widely used in the management of type 2 diabetes, but poor adherence to daily injections often impairs glycaemic control. Once-weekly efsitora alfa may overcome these limitations, but pooled data assessing its comparative efficacy and safety remain limited.

PubMed/MEDLINE, Google Scholar, and the Cochrane Library were searched up to July 2025 for RCTs comparing once-weekly efsitora with once daily insulin in adults with T2D. Weighted mean differences (MDs), odds ratios (ORs), and risk ratios (RRs) were pooled using a random-effects model, and results were reported with 95% confidence intervals.

Six RCTs comprising 3967 participants were included. There were no significant differences between once-weekly efsitora and daily insulin in change in HbA1c (MD -0.04; 95% CI -0.10 to 0.02; p = 0.15), change in fasting plasma glucose (MD 1.94 mg/dL; 95% CI -2.98 to 6.86; p = 0.44), proportion of patients achieving HbA1c < 7%, change in body weight, or time below range. Efsitora was associated with an increase in time in range (MD 0.80 percentage points; 95% CI 0.09 to 1.52; p = 0.03) and a reduction in time above range (MD -1.45 percentage points; 95% CI -2.87 to -0.02; p = 0.05). The risk of treatment-emergent adverse events (TEAEs) was higher with efsitora (RR 1.13; 95% CI 1.05 to 1.20; p = 0.0004), whereas serious adverse events, hypersensitivity reactions, injection-site reactions, and hypoglycaemia events were comparable between the two groups.

Once-weekly efsitora provides comparable glycaemic control and improved time-in-range compared to daily insulin, although with a higher rate of TEAEs.