Comparative cardiovascular outcomes in the era of novel anti-diabetic agents: a comprehensive network meta-analysis of 166,371 participants from 170 randomized controlled trials.
Comparative cardiovascular outcomes in the era of novel anti-diabetic agents: a comprehensive network meta-analysis of 166,371 participants from 170 randomized controlled trials.
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新型抗糖尿病药物时代的心血管结局比较：对来自 170 项随机对照试验的 166,371 名参与者进行的综合网络荟萃分析。
DOI：
10.1186/s12933-018-0722-z
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发表时间：
2018-06-05
影响因子：
9.3
通讯作者：
Liao XX
中科院分区：
文献类型：
--
作者：
Zhuang XD;He X;Yang DY;Guo Y;He JG;Xiao HP;Liao XX
一种抗糖尿病药物相对于另一种药物的心血管（CV）安全性仍有部分描述。我们试图评估新型抗糖尿病药物对CV结局的比较作用。本研究已在国际前瞻性系统评价注册中心（CRD 42016042063）注册。检索了1980年1月1日至2016年6月30日期间的MEDLINE、EMBASE和科克伦图书馆对照试验中央登记册。纳入了在成人2型糖尿病患者中比较抗糖尿病药物与其他对照药物的随机对照试验。我们使用网络荟萃分析来获得利益结果的估计。此外，还按照等级顺序对重度低血糖和主要结局进行了事后相关性分析。结局为主要心血管不良事件（MACE）和全因死亡率。共纳入170项试验（166，371例受试者）。按类别和个人，磺脲类药物（SU）排名最后。因此，以SU为参考，钠-葡萄糖协同转运蛋白2抑制剂（SGLT 2 i）、胰岛素（INS）、胰高血糖素样肽-1受体激动剂和二肽基肽酶4抑制剂在MACE方面明显上级; SGLT 2 i和INS在全因死亡率方面也是如此。此外，MACE和全因死亡率的排序均与严重低血糖风险的排序呈正相关（按个体：R2 = 0.3178，P = 0.018;按类别：R2 = 0.2574，P = 0.038）。新型抗糖尿病药物具有良好的CV安全性特征，尽管个体之间存在微小但稳健的差异。此外，CV风险的增加再次被证明部分归因于伴随的重度低血糖风险的增加，其中SU的表现最差。本文的在线版本（10.1186/s12933-018-0722-z）包含补充材料，可供授权用户使用。
Cardiovascular (CV) safety of one anti-diabetic medication over another remains partially delineated. We sought to assess the comparative effect on CV outcomes among novel anti-diabetic agents. This study was registered with the International Prospective Register of Systematic Reviews (CRD 42016042063). MEDLINE, EMBASE, and Cochrane Library Central Register of Controlled Trials were searched between Jan 1, 1980, and June 30, 2016. Randomized controlled trials comparing anti-diabetic drugs with other comparators in adults with type 2 diabetes were included. We used network meta-analysis to obtain estimates for the outcomes of interests. In addition, post hoc correlation analysis of severe hypoglycemia and primary outcome as per ranking order was conducted. Outcomes were major adverse cardiovascular events (MACE) and all-cause mortality. A total of 170 trials (166,371 participants) were included. By class and by individual, sulfonylureas (SU) ranked last. Therefore, with SU as reference, categorically sodium-glucose co-transporter 2 inhibitor (SGLT2i), insulin (INS), glucagon-like peptide-1 receptor agonist, and dipeptidyl peptidase 4 inhibitor were significantly superior in term of MACE; as were SGLT2i and INS in term of all-cause mortality. Moreover, ranking orders of MACE and all-cause mortality were both positively correlated with that of severe hypoglycemia risk (by individual: R2 = 0.3178, P = 0.018; by class: R2 = 0.2574, P = 0.038). Novel anti-diabetic agents possess favorable CV safety profile, despite small but robust differences between individuals. In addition, increase in CV risk was again shown to be partly attributable to a concomitant increase in the risk of severe hypoglycemia, for which SU performed the worst. The online version of this article (10.1186/s12933-018-0722-z) contains supplementary material, which is available to authorized users.
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影响因子：
158.5
作者：
Holman, Rury R.;Paul, Sanjoy K.;Neil, H. Andrew W.
通讯作者：
Neil, H. Andrew W.
影响因子：
2.6
作者：
Cobitz, Alexander;Zambanini, Andrew;Koch, Gary
通讯作者：
Koch, Gary
DOI：
10.1210/jc.2012-3042
发表时间：
2013-02
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Currie CJ;Poole CD;Evans M;Peters JR;Morgan CL
通讯作者：
Morgan CL
影响因子：
9.3
作者：
Schernthaner G;Lehmann R;Prázný M;Czupryniak L;Ducena K;Fasching P;Janež A;Karasik A;Kempler P;Martinka E;Shestakova MV;Duvnjak LS;Tankova T
通讯作者：
Tankova T
影响因子：
39.2
作者：
Bennett WL;Maruthur NM;Singh S;Segal JB;Wilson LM;Chatterjee R;Marinopoulos SS;Puhan MA;Ranasinghe P;Block L;Nicholson WK;Hutfless S;Bass EB;Bolen S
通讯作者：
Bolen S