DOI
10.1136/bmj-2022-074068
Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials
其他题名
Qingyang Shi;Kailei Nong;Per Olav Vandvik;Gordon H Guyatt;Oliver Schnell;Lars Rydén;Nikolaus Marx;Frank C Brosius III;Reem A Mustafa;Arnav Agarwal;Xinyu Zou;Yunhe Mao;Aminreza Asadollahifar;Saifur Rahman Chowdhury;Chunjuan Zhai;Sana Gupta;Ya Gao;João Pedro Lima;Kenji Numata;Zhi Qiao;Qinlin Fan;Qinbo Yang;Yinghui Jin;Long Ge;Qiuyu Yang;Hongfei Zhu;Fan Yang;Zhe Chen;Xi Lu;Siyu He;Xiangyang Chen;Xiafei Lyu;Xingxing An;Yaolong Chen;Qiukui Hao;Eberhard Standl;Reed Siemieniuk;Thomas Agoritsas;Haoming Tian;Sheyu Li
作者地址
Department of Endocrinology and Metabolism, Division of Guideline and Rapid Recommendation, Cochrane China Centre, MAGIC China Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China
摘要
Objective:To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options.
Design:Systematic review and network meta-analysis.
Data sources:Ovid Medline, Embase, and Cochrane Central up to 14 October 2022.
Eligibility criteria for selecting studies:Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach.
Results:The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes).
Conclusions:This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes.
资助信息
Sichuan Science and Technology Programme (grant 2022YFH0114) and 1.3.5 Clinical Research Incubation Project, West China Hospital, Sichuan University (grant 2020HXF011).
WOS学科分类
Medicine, General & Internal
WOS关键词
SGLT2INHIBITORS
;
HEART-FAILURE
;
EVENTS
;
TIRZEPATIDE
;
FINERENONE
;
OVERWEIGHT
;
GUIDANCE
;
OUTCOMES
;
DISEASE
附件
-
91 Benefits and harms of pharmacotherapy for type 2 diabetes a systematic review.pdf
839.31 kB
除非特别说明，本系统中所有内容都受版权保护，并保留所有权利。
