Impact of SGLT2 inhibitors on patient outcomes: a network meta-analysis

Cardiovascular Diabetology

Research

Wen-Kai Chu¹  Vin-Cent Wu²  Chih-Chung Shiao³  Min-Hsiang Chuang⁴  Tzu-Hsuan Yeh⁴  Jui-Yi Chen⁵  Yafei Yang⁶  Heng-Chih Pan⁷  Chun Yin See⁸ 

[1] Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, 100, Taipei, Taiwan;Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, 100, Taipei, Taiwan;National Taiwan University Hospital Study Group of ARF, NSARF, Taipei, Taiwan;Taiwan Primary Aldosteronism Investigators, TAIPAI, PAC, Taipei, Taiwan;Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong; and Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan, Taiwan;Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan;Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan;Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan;Division of Nephrology, Department of Internal Medicine, Everan Hospital, Taichung, Taiwan;Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan;Chang Gung University College of Medicine, Taoyuan, Taiwan;Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan;Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan;Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan;

关键词: SGLT2 inhibitor;    Diabetes;    Heart failure;    Chronic kidney disease;    Network meta-analysis;   

DOI  :  10.1186/s12933-023-02035-8

 received in 2023-09-24, accepted in 2023-10-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundA comprehensive network meta-analysis comparing the effects of individual sodium-glucose cotransporter 2 (SGLT2) inhibitors on patients with and without comorbidities including diabetes mellitus (DM), heart failure (HF), and chronic kidney disease (CKD) has not been previously conducted.MethodsWe searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials up to March 28, 2023. Network meta-analysis using a random-effects model was conducted to calculate risk ratios (RRs). Risk of Bias tool 2.0 was used to assess bias, and CINeMA to assess the certainty of evidence. In the subgroup analysis, the SGLT2 inhibitors were classified into highly (dapagliflozin, empagliflozin, and ertugliflozin) and less selective SGLT2 inhibitors (canagliflozin and sotagliflozin).ResultsA total of fourteen trials with 75,334 patients were analyzed. Among these, 40,956 had taken SGLT2 inhibitors and 34,378 had not. One of the main results with particular findings was empagliflozin users had a significantly lower risk of all-cause death compared to dapagliflozin users in DM population (RR: 0.81, 95% CI 0.69–0.96). In HF population, sotagliflozin users had a borderline significantly lower risk of CV death or hospitalization for HF (HHF) than dapagliflozin users (RR: 0.90, 95% CI 0.80–1.01). In non-HF population, those who used canagliflozin had a significantly lower risk of CV death or HHF compared with those who used dapagliflozin (RR: 0.75, 95% CI 0.58–0.98). At last, for HF patients, those who used less selective SGLT2 inhibitors had a significantly lower risk of MACEs compared to those who used highly selective SGLT2 inhibitors (RR: 0.75, 95% CI 0.62–0.90).ConclusionsOur network meta-analysis revealed that empagliflozin users with diabetes experienced a lower risk of dying from any cause than those using dapagliflozin. Additionally, canagliflozin users demonstrated a reduced risk of cardiovascular death or HHF compared to dapagliflozin users in those without HF. In HF patients, less selective SGLT2 inhibitors showed superior CV composite outcomes, even surpassing the performance of highly selective SGLT2 inhibitors.Trial registration: PROSPERO [CRD42022361906].

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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