Cardiovascular efficacy and safety of antidiabetic agents: A network meta‐analysis of randomized controlled trials

医学 狼牙棒 不利影响 赛马鲁肽 随机对照试验 安慰剂 内科学 中止 2型糖尿病 心力衰竭 艾塞那肽 危险系数 药理学 重症监护医学 糖尿病 内分泌学 利拉鲁肽 置信区间 心肌梗塞 替代医学 病理 传统PCI
作者
Minji Sohn,Juan P. Frías,Soo Lim
出处
期刊:Diabetes, Obesity and Metabolism [Wiley]
卷期号:25 (12): 3560-3577 被引量:8
标识
DOI:10.1111/dom.15251
摘要

An important characteristic of glucose-lowering therapies (GLTs) is their ability to prevent cardiovascular complications. We aimed to investigate the cardiorenal efficacy and general safety of GLTs.Multicentre, randomized, clinical trials that included over 100 participants comparing antidiabetic agents with a placebo or a different antidiabetic agent and reporting major adverse cardiovascular events (MACEs), or primarily reporting heart failure, were searched in the PubMed, Embase and Cochrane databases. Data were extracted independently for random-effects network meta-analyses to calculate the hazard ratio estimates.Forty-three trials that compared nine types of GLTs were included in the present analysis. The risk of three-point MACE was reduced in the presence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and thiazolidinedione therapy compared with the placebo, dipeptidyl peptidase-4 inhibitors, or insulin therapy. GLP-1 RAs were favourable for cardiovascular and renal outcomes. SGLT-2is reduced renal outcomes by ~40%, which was superior to other GLTs. Thiazolidinedione therapy increased the risks of hospitalization for heart failure and had no benefits on mortality. Adverse events leading to drug discontinuation were higher with GLP-1 RAs and thiazolidinediones than placebo.GLP-1 RAs, SGLT-2is and thiazolidinediones reduced three-point MACE compared with other GLTs. Each drug class had unique advantages and disadvantages.
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