背景:钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)的新心力衰竭(HF)疗法,Vericiguat,omecamtivmecarbil主要不是通过神经激素阻滞发挥作用,但已显示出射血分数(HFrEF)降低的HF患者的临床益处。然而,它们各自的功效尚不清楚。我们的目的是评估HFrEF新药的相对疗效。
方法:我们对比较SGLT2i,Vericiguat,omecamtivmecarbil,和HFrEF患者的安慰剂。主要终点是心血管死亡(CVD)或HF住院(CVD-HF)的复合;次要终点是CVD,全因死亡,和HF住院(HFH)。
结果:纳入12个RCT(n=23,861例)。与安慰剂相比,SGLT2i观察到CVD-HF的显着降低(风险比(RR)0.77,95%置信区间(CI)0.71-0.83),Vericiguat(RR0.84,95%CI0.75-0.93),和omecamtivmecarbil(RR0.80,95%CI0.72-0.88)。Vericiguat和omecamtivmecarbil之间没有观察到显着差异(RR0.95,95%CI0.87-1.04)。SGLT2i在所有个体次要终点方面均优于安慰剂和omecamtivmecarbil(CVD,全因死亡,和HFH),也是HFH的vericiguat。SGLT2i被列为所有终点最有效的治疗方法,和Vericiguat,omecamtivmecarbil,安慰剂排名第二,第三,和最后的选择,分别,用于主端点。
结论:在接受标准治疗的HFrEF患者中,与安慰剂相比,SGLT2i治疗与降低CVD-HF风险相关,Vericiguat,和omecamtivmecarbil。此外,SGLT2i在CVD方面优于安慰剂和omecamtivmecarbil,全因死亡,和HFH,也是HFH的vericiguat。
BACKGROUND: The new heart failure (HF) therapies of sodium-glucose cotransporter 2 inhibitors (SGLT2i), vericiguat, and omecamtiv mecarbil do not act primarily through the neuro-hormonal blockade, but have shown clinical benefits in patients with HF with reduced ejection fraction (HFrEF). However, their respective efficacies remain unclear. Our aim was to evaluate the relative efficacy of new drugs for HFrEF.
METHODS: We performed a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing SGLT2i, vericiguat, omecamtiv mecarbil, and placebo in HFrEF patients. The primary endpoint was the composite of cardiovascular death (CVD) or HF hospitalization (CVD-HF); secondary endpoints were CVD, all-cause death, and HF hospitalization (HFH).
RESULTS: Twelve RCTs (n = 23,861 patients) were included. A significant reduction in CVD-HF was observed with SGLT2i compared with placebo (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.71-0.83), vericiguat (RR 0.84, 95% CI 0.75-0.93), and omecamtiv mecarbil (RR 0.80, 95% CI 0.72-0.88). No significant difference was observed between vericiguat and omecamtiv mecarbil (RR 0.95, 95% CI 0.87-1.04). SGLT2i were superior to placebo and omecamtiv mecarbil for all individual secondary endpoints (CVD, all-cause death, and HFH), and also to vericiguat for HFH. SGLT2i ranked as the most effective therapy for all endpoints, and vericiguat, omecamtiv mecarbil, and placebo ranked as the second, third, and last options, respectively, for the primary endpoint.
CONCLUSIONS: In patients with HFrEF on standard-of-care therapy, SGLT2i therapy was associated with a reduced risk of CVD-HF compared to placebo, vericiguat, and omecamtiv mecarbil. Furthermore, SGLT2i were superior to placebo and omecamtiv mecarbil for CVD, all-cause death, and HFH, and also to vericiguat for HFH.