Comparative effectiveness of canagliflozin, SGLT2 inhibitors and non‐SGLT2 inhibitors on the risk of hospitalization for heart failure and amputation in patients with type 2 diabetes mellitus: A real‐world meta‐analysis of 4 observational databases (OBSERVE‐4D)
Autor: | Frank J. DeFalco, Martijn J. Schuemie, John B. Buse, Paul E. Stang, Zhong Yuan, Patrick B. Ryan, Norman Rosenthal, Jesse A. Berlin |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Amputation Surgical Young Adult 03 medical and health sciences 0302 clinical medicine Endocrinology Risk Factors Internal medicine Diabetes mellitus Internal Medicine medicine Humans Canagliflozin Sodium-Glucose Transporter 2 Inhibitors Aged Retrospective Studies Aged 80 and over Heart Failure business.industry Type 2 Diabetes Mellitus Middle Aged medicine.disease Diabetic Foot 3. Good health Hospitalization Observational Studies as Topic Treatment Outcome Databases as Topic Diabetes Mellitus Type 2 Amputation Meta-analysis Heart failure Female Observational study business Diabetic Angiopathies medicine.drug |
Zdroj: | Diabetes, Obesity and Metabolism. 20:2585-2597 |
ISSN: | 1463-1326 1462-8902 |
Popis: | Sodium glucose co-transporter 2 inhibitors (SGLT2i) are indicated for treatment of type 2 diabetes mellitus (T2DM); some SGLT2i have reported cardiovascular benefit, and some have reported risk of below-knee lower extremity (BKLE) amputation. This study examined the real-world comparative effectiveness within the SGLT2i class and compared with non-SGLT2i antihyperglycaemic agents.Data from 4 large US administrative claims databases were used to characterize risk and provide population-level estimates of canagliflozin's effects on hospitalization for heart failure (HHF) and BKLE amputation vs other SGLT2i and non-SGLT2i in T2DM patients. Comparative analyses using a propensity score-adjusted new-user cohort design examined relative hazards of outcomes across all new users and a subpopulation with established cardiovascular disease.Across the 4 databases (142 800 new users of canagliflozin, 110 897 new users of other SGLT2i, 460 885 new users of non-SGLT2i), the meta-analytic hazard ratio estimate for HHF with canagliflozin vs non-SGLT2i was 0.39 (95% CI, 0.26-0.60) in the on-treatment analysis. The estimate for BKLE amputation with canagliflozin vs non-SGLT2i was 0.75 (95% CI, 0.40-1.41) in the on-treatment analysis and 1.01 (95% CI, 0.93-1.10) in the intent-to-treat analysis. Effects in the subpopulation with established cardiovascular disease were similar for both outcomes. No consistent differences were observed between canagliflozin and other SGLT2i.In this large comprehensive analysis, canagliflozin and other SGLT2i demonstrated HHF benefits consistent with clinical trial data, but showed no increased risk of BKLE amputation vs non-SGLT2i. HHF and BKLE amputation results were similar in the subpopulation with established cardiovascular disease. This study helps further characterize the potential benefits and harms of SGLT2i in routine clinical practice to complement evidence from clinical trials and prior observational studies. |
Databáze: | OpenAIRE |
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