Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials

被引：472

作者：

Palmer, Suetonia C. ^{[1
]}

Tendal, Britta ^{[2
]}

Mustafa, Reem A. ^{[3
,4
]}

Vandvik, Per Olav ^{[5
]}

Li, Sheyu ^{[6
,7
]}

Hao, Qiukui ^{[8
]}

Tunnicliffe, David ^{[9
]}

Ruospo, Marinella ^{[10
]}

Natale, Patrizia ^{[9
,10
]}

Saglimbene, Valeria ^{[10
]}

Nicolucci, Antonio ^{[11
]}

Johnson, David W. ^{[12
]}

Tonelli, Marcello ^{[13
]}

Rossi, Maria Chiara ^{[11
]}

Badve, Sunil, V ^{[14
]}

Cho, Yeoungjee ^{[12
]}

Nadeau-Fredette, Annie-Claire ^{[15
]}

Burke, Michael ^{[16
]}

Faruque, Labib, I ^{[17
]}

Lloyd, Anita ^{[17
]}

Ahmad, Nasreen ^{[17
]}

Liu, Yuanchen ^{[17
]}

Tiv, Sophanny ^{[17
]}

Millard, Tanya ^{[2
]}

Gagliardi, Lucia ^{[18
,19
]}

Kolanu, Nithin ^{[20
]}

Barmanray, Rahul D. ^{[21
]}

McMorrow, Rita ^{[22
]}

Cortez, Ana Karina Raygoza ^{[23
]}

White, Heath ^{[2
]}

Chen, Xiangyang ^{[6
]}

Zhou, Xu ^{[24
]}

Liu, Jiali ^{[25
]}

Rodriguez, Andrea Flores ^{[23
]}

Gonzalez-Colmenero, Alejandro Diaz ^{[23
]}

Wang, Yang ^{[26
]}

Li, Ling ^{[25
]}

Sutanto, Surya ^{[27
]}

Solis, Ricardo Cesar ^{[23
]}

Gonzalez-Colmenero, Fernando Diaz ^{[23
]}

Rodriguez-Gutierrez, Rene ^{[23
]}

Walsh, Michael ^{[28
,29
]}

Guyatt, Gordon ^{[4
]}

Strippoli, Giovanni F. M. ^{[9
,10
]}

机构：

[1] Univ Otago, Dept Med, Christchurch, New Zealand

[2] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia

[3] Univ Kansas, Dept Internal Med, Div Nephrol & Hypertens, Kansas City, KS USA

[4] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[5] Univ Oslo, Inst Hlth & Soc, Oslo, Norway

[6] Sichuan Univ, West China Hosp, Dept Endocrinol & Metab, Chengdu, Peoples R China

[7] Univ Dundee, Ninewells Hosp, Div Populat Hlth & Genom, Dundee, Scotland

[8] Sichuan Univ, West China Hosp, Ctr Gerontol & Geriatr, Chengdu, Peoples R China

[9] Univ Sydney, Sydney Sch Publ Hlth, Sydney, NSW, Australia

[10] Univ Bari, Dept Emergency & Organ Transplantat, Piazza Giulio CESARE, I-70124 Bari, Italy

[11] Ctr Outcomes Res & Clin Epidemiol CORES, Pescara, Italy

[12] Univ Queensland, Dept Nephrol, Div Med, Princess Alexandra Hosp, Woolloongabba, Qld, Australia

[13] Univ Calgary, Cumming Sch Med, Calgary, AB, Canada

[14] George Inst Global Hlth, Sydney, NSW, Australia

[15] Hop Maison Neuve Rosemont, Div Nephrol, Montreal, PQ, Canada

[16] Mater Private Clin, Brisbane, Qld, Australia

[17] Univ Alberta, Fac Med & Dent, Dept Nephrol, Edmonton, AB, Canada

[18] Queen Elizabeth Hosp, Endocrine & Diabet Unit, Woodville, SA, Australia

[19] Royal Adelaide Hosp, Endocrine & Metab Unit, Adelaide, SA, Australia

[20] Garvan Inst Med Res, Sydney, NSW, Australia

[21] Univ Melbourne, Dept Med, Melbourne, Vic, Australia

[22] Univ Melbourne, Dept Gen Practice & Primary Hlth Care, Melbourne, Vic, Australia

[23] Univ Autonoma Nuevo Leon, Plataforma INVEST Med UANL KER Unit Mayo Clin, KER Unit Mexico, Monterrey, Mexico

[24] Jiangxi Univ Tradit Chinese Med, Evidence Based Med Res Ctr, Nanchang, Jiangxi, Peoples R China

[25] Cochrane China Ctr, Chinese Evidence Based Med Ctr, Chengdu, Peoples R China

[26] Sichuan Univ, West China Sch Med, Chengdu, Peoples R China

[27] Univ Sydney, Fac Med & Hlth, Charles Perkins Ctr, Sydney, NSW, Australia

[28] McMaster Univ, Dept Med, Hamilton, ON, Canada

[29] McMaster Univ, Populat Hlth Res Inst, Hamilton Hlth Sci, Hamilton, ON, Canada

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2021年 / 372卷

关键词：

CHRONIC KIDNEY-DISEASE; DIPEPTIDYL PEPTIDASE-4 INHIBITOR; SEVERE RENAL IMPAIRMENT; LONG-TERM EFFICACY; CARDIOVASCULAR OUTCOMES; DOUBLE-BLIND; CORONARY ATHEROSCLEROSIS; LOWERING DRUGS; PIOGLITAZONE TREATMENT; INSULIN-RESISTANCE;

D O I：

10.1136/bmj.m4573

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. DESIGN Network meta-analysis. DATA SOURCES Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. MAIN OUTCOME MEASURES Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. RESULTS 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced mortality and admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very

引用

页数：14

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