With multiple disease‐modifying therapies now available, treatment switching has become an important clinical consideration in the management of spinal muscular atrophy (SMA). While some switches are prompted by suboptimal clinical response, more commonly they are driven by treatment burden, convenience, or adverse events. This systematic literature review aimed to synthesize existing evidence on therapy switching in SMA, focusing on clinical effectiveness and practical implications to support evidence‐informed decision‐making in a rapidly evolving therapeutic landscape. The review followed PRISMA guidelines and was registered with PROSPERO (CRD42024600221). A systematic search of PubMed/MEDLINE, Global Health and Embase was conducted between 11 and 14 October 2024. Eligible studies included clinical trials and real‐world evidence (RWE) reports describing patients with genetically confirmed SMA who received nusinersen or risdiplam and subsequently switched to nusinersen, risdiplam or onasemnogene abeparvovec. Four studies met the inclusion criteria—three RWE studies and one clinical trial. The variability in measures of central tendency and variability among studies precluded the calculation of pooled summary values. Nonetheless, switching treatments was generally associated with stable motor function, with some improvements reported in selected outcome measures; ventilatory and nutritional support requirements remained largely unchanged. However, long‐term outcomes and standardized data were limited. Future research should prioritize robust RWE and post‐marketing surveillance to evaluate long‐term safety and effectiveness, incorporate standardized switching protocols, and account for SMA genotype–phenotype variation.

Diabetes is a chronic, metabolic disease characterized by hyperglycemia, which occurs as a result of inadequate production or utilization of insulin. Type 2 diabetes (T2D) is the most common type of diabetes with estimates projecting a prevalence of more than 1 billion people living with T2DM by 2050. Hence, it was decided to conduct a systematic literature review of health economic evaluations of insulin, the most common medication used for the treatment of the disease, to inform policy. Pharmacoeconomic analyses, written in English and published after 2016, were considered for inclusion. PubMed/Medline, Global Health, Embase and Health Management Consortium were searched separately between 5 July 2023 and 17 July 2023. Grey literature articles were searched on ISPOR and the Cost-Effectiveness Analysis Registry during the same period. After the exclusion criteria were applied, 21 studies were included. Using the BMJ checklist, a quality appraisal was performed on all included studies. Data extraction was performed manually. Regarding evidence synthesis, data were heterogenous and are presented based on study type. The results showed a variety of treatment combinations being available for the treatment of diabetes, with insulin degludec/DegLira and semaglutide being cost-effective despite their high cost, due to the effectiveness of managing the disease. Research around the cost-effectiveness or cost-utility of insulin has potential to progress further, to ensure informed policy-making in the future.

Aim: Metabolic liver disease, including nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis, is a major cause of chronic liver dysfunction worldwide, creating an urgent need for effective treatments. This systematic literature review (SLR) and network meta‐analysis (NMA) systematically reviews and compares the efficacy and safety of glucagon‐like peptide‐1 receptor agonists, tirzepatide and sodium–glucose co‐transporter‐2 inhibitors for this condition. The results of the SLR and NMA were reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Methods: The MEDLINE and EMBASE databases, as well as the Cochrane Central Register of Controlled Trials, were systematically searched for publications from database inception to 9 November 2024. Risk of bias assessment of the included randomized clinical trials was performed using the Cochrane Risk of Bias 2 tool. Effect sizes were synthesized using pairwise and NMAs within a random‐effects framework, assessing heterogeneity and estimating treatment rankings via the surface under the cumulative ranking curve. Analyses were performed using R software with the ‘netmeta’ package. Results: Overall, 25 studies involving 2688 participants were included in the analysis. Exenatide and tirzepatide significantly reduced liver fat fraction and liver enzymes vs . placebo, outperforming liraglutide and other agents. Liraglutide and dapagliflozin improved hepatic steatosis by controlled attenuation parameter, whereas empagliflozin reduced proton density fat fraction dose‐dependently. Conclusion: This NMA demonstrated that GLP‐1 RAs, SGLT‐2 inhibitors and tirzepatide significantly improve surrogate markers of NAFLD, with exenatide and tirzepatide showing the greatest efficacy in reducing hepatic steatosis. PROSPERO ID CRD42024609736.