Efficacy and tolerability of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists: A systematic review and network meta-analysis
| Autor: | Emily Patsko, Laura J. Gray, Kamlesh Khunti, Ekaterini Ioannidou, Melanie J. Davies, Nafeesa N. Dhalwani, Francesco Zaccardi, David E Kloecker, Humaira Hussein |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism Network Meta-Analysis 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Placebo Gastroenterology Glucagon-Like Peptide-1 Receptor law.invention 03 medical and health sciences 0302 clinical medicine Endocrinology Randomized controlled trial law Internal medicine Internal Medicine medicine Humans Hypoglycemic Agents Adverse effect Sodium-Glucose Transporter 2 Inhibitors Symporters business.industry Semaglutide Sodium Bayes Theorem Odds ratio medicine.disease Blood pressure Glucose Tolerability Diabetes Mellitus Type 2 business |
| Zdroj: | Diabetes, obesitymetabolismREFERENCES. 22(7) |
| ISSN: | 1463-1326 |
| Popis: | Aim To compare the efficacy and tolerability of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in adults with type 2 diabetes. Materials and methods Electronic databases were searched from inception to 24 April 2019 for randomized controlled trials reporting change in glycated haemoglobin (HbA1c) at approximately 24 and/or 52 weeks for SGLT-2is and/or GLP-1RAs (classified as short- and long-acting). Bayesian network meta-analyses were conducted to compare within and between SGLT-2i and GLP-1RA classes for cardiometabolic efficacy and adverse events (PROSPERO registration number: CRD42018091306). Results Sixty-four trials (53 trials of 24 weeks; seven trials of 52 weeks; four trials of both 24 and 52 weeks), comprising 31 384 participants were identified. Compared with placebo, all treatments improved HbA1c. Long-acting GLP-1RAs reduced HbA1c compared with short-acting GLP-1RAs and SGLT-2is, with semaglutide showing greater reduction compared with placebo [24 weeks: -1.49% (95% credible interval: -1.76, -1.22); 52 weeks: -1.38% (-2.05, -0.71)] and all other treatments. Long-acting GLP-1RAs showed benefits in body weight and waist circumference reduction, while SGLT-2is reduced blood pressure. SGLT-2is showed increased risk of genital infection in comparison with long-acting GLP-1RAs [odds ratio (95% credible interval): 5.26 (1.45, 25.00)], while GLP-1RAs showed increased risk of diarrhoea in comparison with SGLT-2is [short-acting GLP-1RAs: 1.65 (1.09, 2.49); long-acting GLP-1RAs: 2.23 (1.51, 3.28)]. No other differences were found between SGLT-2is and GLP-1RAs in adverse events. Conclusion Long-acting GLP-1RAs showed superiority in reducing HbA1c levels, body weight and waist circumference. SGLT-2is showed reductions in blood pressure levels. This review provides essential evidence to guide treatment recommendations in the management of type 2 diabetes. |
| Databáze: | OpenAIRE |
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