Cardiovascular and renal outcomes with SGLT-2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus and chronic kidney disease: a systematic review and network meta-analysis.
Cardiovascular and renal outcomes with SGLT-2 inhibitors versus GLP-1 receptor agonists in patients with type 2 diabetes mellitus and chronic kidney disease: a systematic review and network meta-analysis.
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DOI：
10.1186/s12933-020-01197-z
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发表时间：
2021-01-07
影响因子：
9.3
通讯作者：
Tamura K
中科院分区：
文献类型：
--
作者：
Yamada T;Wakabayashi M;Bhalla A;Chopra N;Miyashita H;Mikami T;Ueyama H;Fujisaki T;Saigusa Y;Yamaji T;Azushima K;Urate S;Suzuki T;Abe E;Wakui H;Tamura K
新出现的证据表明，钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂和胰高血糖素样肽-1受体激动剂（GLP-1 RA）与2型糖尿病（DM）患者心血管和肾脏事件风险降低相关。然而，迄今为止，尚无研究比较SGLT-2抑制剂与GLP-1 RA在2型DM伴慢性肾脏疾病（CKD）患者中的作用。我们在此研究了SGLT-2抑制剂和GLP-1 RA在CKD患者中的获益。我们进行了系统性文献检索，直至2020年11月。我们选择了比较主要心血管不良事件（MACE）风险和肾脏结局复合指标的随机对照试验。我们进行了一项网络荟萃分析，以间接比较SGLT-2抑制剂与GLP-1 RA。综合风险比（RR）和相应的95%置信区间（CI）。选择了13项研究，共32，949例患者。SGLT-2抑制剂导致MACE和肾脏事件风险降低（RR [95% CI];分别为0.85 [0.75-0.96]和0.68 [0.59-0.78]）。然而，GLP-1 RA并未降低心血管或肾脏不良事件的风险（RR分别为0.91 [0.80-1.04]和0.86 [0.72-1.03]）。与GLP-1 RA相比，SGLT-2抑制剂在MACE方面未显示出显著差异（RR 0.94 [0.78-1.12]），而与GLP-1 RA相比，SGLT-2抑制剂与较低的肾脏事件风险相关（RR 0.79 [0.63-0.99]）。敏感性分析显示，与安慰剂治疗相比，GLP-1类似物显著降低MACE（RR 0.81 [0.69-0.95]），而毒蜥外泌肽-4类似物则没有（RR 1.03 [0.88-1.20]）。在2型DM和CKD患者中，SGLT-2抑制剂与心血管和肾脏事件风险降低相关，但GLP-1 RA与此无关。与GLP-1 RA相比，SGLT-2抑制剂显著降低了肾脏事件的风险。在GLP-1 RA中，GLP-1类似物对心血管和肾脏结局显示出积极影响，而exendin-4类似物则没有。
Emerging evidence suggests that sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with decreased risk of cardiovascular and renal events in type 2 diabetes mellitus (DM) patients. However, no study to date has compared the effect of SGLT-2 inhibitors with that of GLP-1 RAs in type 2 DM patients with chronic kidney disease (CKD). We herein investigated the benefits of SGLT-2 inhibitors and GLP-1 RAs in CKD patients. We performed a systematic literature search through November 2020. We selected randomized control trials that compared the risk of major adverse cardiovascular events (MACE) and a composite of renal outcomes. We performed a network meta-analysis to compare SGLT-2 inhibitors with GLP-1 RAs indirectly. Risk ratios (RRs) with corresponding 95% confidence intervals (CI) were synthesized. Thirteen studies were selected with a total of 32,949 patients. SGLT-2 inhibitors led to a risk reduction in MACE and renal events (RR [95% CI]; 0.85 [0.75–0.96] and 0.68 [0.59–0.78], respectively). However, GLP-1 RAs did not reduce the risk of cardiovascular or renal adverse events (RR 0.91 [0.80–1.04] and 0.86 [0.72–1.03], respectively). Compared to GLP-1 RAs, SGLT-2 inhibitors did not demonstrate a significant difference in MACE (RR 0.94 [0.78–1.12]), while SGLT-2 inhibitors were associated with a lower risk of renal events compared to GLP-1 RAs (RR 0.79 [0.63–0.99]). A sensitivity analysis revealed that GLP-1 analogues significantly decreased MACE when compared to placebo treatment (RR 0.81 [0.69–0.95]), while exendin-4 analogues did not (RR 1.03 [0.88–1.20]). In patients with type 2 DM and CKD, SGLT-2 inhibitors were associated with a decreased risk of cardiovascular and renal events, but GLP-1 RAs were not. SGLT-2 inhibitors significantly decreased the risk of renal events compared to GLP-1 RAs. Among GLP-1 RAs, GLP-1 analogues showed a positive impact on cardiovascular and renal outcomes, while exendin-4 analogues did not.