Comparative outcomes of heart failure among existent classes of anti-diabetic agents: a network meta-analysis of 171,253 participants from 91 randomized controlled trials
Comparative outcomes of heart failure among existent classes of anti-diabetic agents: a network meta-analysis of 171,253 participants from 91 randomized controlled trials
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现有抗糖尿病药物类别的心力衰竭结果比较：对来自 91 项随机对照试验的 171,253 名参与者进行的网络荟萃分析
DOI：
10.1186/s12933-019-0853-x
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发表时间：
2019
影响因子：
9.3
通讯作者：
Xin-xue Liao
中科院分区：
文献类型：
--
作者：
Da-ya Yang;Xin He;Hui-wei Liang;Shao-zhao Zhang;Xiang-bin Zhong;Chu-fan Luo;Zhi-min Du;Jian-gui He;Xiao-dong Zhuang;Xin-xue Liao
背景不同类型的治疗方法对心力衰竭的心血管(CV)安全性在很大程度上仍不清楚。我们试图评估这些药物对心力衰竭结局的比较效果。方法该研究登记在《国际系统评价前瞻性登记》(CRD 42016042063)上。检索Medline、EMBASE和Cochrane图书馆对照试验中央登记处。对于之前报告的主要结果，对1980年1月1日至2016年6月30日之间的研究进行了筛选，随后更新至2019年1月24日。我们进行了网络荟萃分析，以获得对心力衰竭结果的估计，特别是通过心力衰竭风险排名的秩序图以及所有类别的抗糖尿病药物之间的配对比较。结果共纳入91项试验，其中171,253名参与者和4163例报告的心力衰竭事件。对于等级图，钠-葡萄糖共转运体2和噻唑烷二酮的累积排序曲线下表面(SUCRA)分别为93.4%和4.3%，分别表示心力衰竭的风险最低和最高。在网络中的配对比较中，钠-葡萄糖共转运体2在心力衰竭风险方面明显优于胰岛素(OR：0.75，95%CI 0.62~0.91)、二肽基肽酶4抑制剂(OR：0.68，95%CI 0.59~0.78)、胰高血糖素样肽1受体激动剂(OR：0.65，95%CI 0.54~0.78)和噻唑烷二酮类药物(OR：0.46，95%CI 0.27~0.77)。此外，在对潜在心力衰竭或有心力衰竭风险的受试者进行的探索性分析中，钠-葡萄糖共转运体2的优势仍然显著。结论就心力衰竭风险而言，钠-葡萄糖共转运体2是所有类别抗糖尿病药物中最有利的选择。
BackgroundThe cardiovascular (CV) safety in terms of heart failure among different classes of treatment remains largely unknown. We sought to assess the comparative effect of these agents on heart failure outcomes.MethodsThis study was registered in the International Prospective Register of Systematic Reviews (CRD 42016042063). MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched. For the primary outcomes reported previously, studies between Jan 1, 1980 and June 30, 2016 were screened, and subsequently updated till Jan 24, 2019. We performed network meta-analysis to obtain estimates for the outcomes of heart failure, in particular by rankograms for ranking of heart failure risk as well as by pairwise comparisons among all classes of anti-diabetic medications.ResultsA total of 91 trials were included, among which were 171,253 participants and 4163 reported cases of heart failure events. As for rankograms, the surface under the cumulative ranking curves (SUCRA) of sodium-glucose co-transporters 2 and thiazolidinediones were 93.4% and 4.3%, respectively, signifying the lowest and highest risk of heart failure, respectively. As for pairwise comparisons in the network, sodium-glucose co-transporters 2 were significantly superior to insulin (OR: 0.75, 95% CI 0.62–0.91), dipeptidyl peptidase 4 inhibitors (OR: 0.68, 95% CI 0.59–0.78), glucagon-like peptide-1 receptor agonists (OR: 0.65, 95% CI 0.54–0.78), and thiazolidinediones (OR: 0.46, 95% CI 0.27–0.77) in terms of heart failure risk. Furthermore, in an exploratory analysis among subjects with underlying heart failure or at risk of heart failure, the superiority of sodium-glucose co-transporters 2 was still significant.ConclusionsIn terms of heart failure risk, sodium-glucose co-transporters 2 were the most favorable option among all classes of anti-diabetic medications.