医学
肾脏疾病
MRAS公司
盐皮质激素受体
内科学
2型糖尿病
安慰剂
联合疗法
随机对照试验
高钾血症
糖尿病
科克伦图书馆
药理学
内分泌学
醛固酮
病理
病媒控制
电压
替代医学
物理
感应电动机
量子力学
作者
Shunichiro Tsukamoto,Ryutaro Morita,Takayuki Yamada,Shingo Urate,Kengo Azushima,Kazushi Uneda,Ryu Kobayashi,Tomohiko Kanaoka,Hiromichi Wakui,Kouichi Tamura
标识
DOI:10.1016/j.diabres.2022.110161
摘要
Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular (CV) event in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, little evidence pertains to the benefits of their combined use.We systematically searched the PubMed, MEDLINE, EMBASE, and Cochrane Library databases through July 2022. We selected randomized controlled trials comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination therapy, with placebo in patients with T2D and CKD. We performed a network meta-analysis to indirectly compare the treatments. The primary outcome was a composite of CV events.Eight studies were selected with 36,186 patients. The primary outcome was significantly improved in the combination therapy group compared with the other groups (RR [95% CI]; vs SGLT-2 inhibitors, 0.76 [0.60; 0.96]; vs MRAs, 0.66 [0.53; 0.82]; vs placebo, 0.58 [0.47; 0.73]). Additionally, the combination therapy was associated with a considerable reduction in the risk of hyperkalemia (RR vs MRA, 0.43 [0.23; 0.79]).Combination of SGLT-2 inhibitors and MRAs potentially reduced CV events compared with SGLT-2 inhibitors or MRAs alone. This combination may be a candidate treatment strategy for patients with T2D and CKD.
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