Combination Therapy with an SGLT2 Inhibitor as Initial Treatment for Type 2 Diabetes: A Systematic Review and Meta-Analysis
| Autor: | Lucy McGrath-Cadell, Dorit Samocha-Bonet, Tamara Y. Milder, Christina Abdel Shaheed, Richard O. Day, Sophie L. Stocker, Jerry R. Greenfield |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Combination therapy lcsh:Medicine 030209 endocrinology & metabolism Type 2 diabetes Review Cochrane Library Gastroenterology 03 medical and health sciences pharmacotherapy 0302 clinical medicine Pharmacotherapy Weight loss Internal medicine DPP-4 inhibitors Medicine 030212 general & internal medicine business.industry lcsh:R General Medicine medicine.disease Metformin Relative risk type 2 diabetes clinical pharmacology SGLT2 Inhibitor medicine.symptom business metformin SGLT2 inhibitors medicine.drug |
| Zdroj: | Journal of Clinical Medicine Journal of Clinical Medicine, Vol 8, Iss 1, p 45 (2019) |
| ISSN: | 2077-0383 |
| Popis: | Background: Guidelines differ with regard to indications for initial combination pharmacotherapy for type 2 diabetes. Aims: To compare the efficacy and safety of (i) sodium-glucose cotransporter 2 (SGLT2) inhibitor combination therapy in treatment-naïve type 2 diabetes adults; (ii) initial high and low dose SGLT2 inhibitor combination therapy. Methods: PubMed, Embase and Cochrane Library were searched for randomised controlled trials (RCTs) of initial SGLT2 combination therapy. Mean difference (MD) for changes from baseline (HbA1c, weight, blood pressure) after 24–26 weeks of treatment and relative risks (RR, safety) were calculated using a random-effects model. Risk of bias and quality of evidence was assessed. Results: In 4 RCTs (n = 3749) there was moderate quality evidence that SGLT2 inhibitor/metformin combination therapy resulted in a greater reduction in HbA1c (MD (95% CI); −0.55% (−0.67, −0.43)) and weight (−2.00 kg (−2.34, −1.66)) compared with metformin monotherapy, and a greater reduction in HbA1c (−0.59% (−0.72, −0.46)) and weight (−0.57 kg (−0.89, −0.25)) compared with SGLT2 inhibitor monotherapy. The high dose SGLT2 inhibitor/metformin combination resulted in a similar HbA1c but greater weight reduction; −0.47 kg (−0.88, −0.06) than the low dose combination therapy. The RR of genital infection with combination therapy was 2.22 (95% CI 1.33, 3.72) and 0.69 (95% CI 0.50, 0.96) compared with metformin and SGLT2 inhibitor monotherapy, respectively. The RR of diarrhoea was 2.23 (95% CI 1.46, 3.40) with combination therapy compared with SGLT2 inhibitor monotherapy. Conclusions: Initial SGLT2 inhibitor/metformin combination therapy has glycaemic and weight benefits compared with either agent alone and appears relatively safe. High dose SGLT2 inhibitor/metformin combination therapy appears to have modest weight, but no glycaemic benefits compared with the low dose combination therapy. |
| Databáze: | OpenAIRE |
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