■在2型糖尿病(T2D)和心力衰竭(HF)病史的患者中,钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2is)已经证明了心血管(CV)的益处。然而,个别SGLT2的比较疗效仍不确定.这项网络荟萃分析(NMA)比较了五种SGLT2is(canagliflozin,dapagliflozin,empagliflozin,ertugliflozin,和sotagliflozin)对这些患者的CV结果。
■PubMed,Embase,并在2022年9月23日之前检索了Cochrane中央对照试验注册中心,以确定在T2DHF患者中比较SGLT2is和安慰剂的所有随机对照试验(RCT).主要结果包括复合CV死亡/心力衰竭住院(HFH),HFH,CV死亡,全因死亡率,和不良事件。应用了成对和NMA方法。
■我们的分析包括11项RCT,共有20,438例T2D和HF患者。与单独的护理标准(SoC)相比,所有SGLT2显著降低HFH。\"Add-on\"SGLT2is,除了Ertugliflozin,与单用SoC相比,复合CV死亡/HFH显著降低。此外,与达格列净相比,卡格列净的复合CV死亡/HFH较低。基于累积排名曲线(SUCRA)下的曲面,用于减少HFH的排名最高的SGLT2is是canagliflozin(95.5%),索格列净(66.0%),和依帕列净(57.2%)。头对头比较发现,各个SGLT2is在减少CV死亡方面没有显着差异。\"Add-on\"SGLT2与单用SoC相比降低了全因死亡率,尽管只有达格列净有统计学意义。没有SGLT2is与严重不良事件显著相关。一项针对HF特异性试验的敏感性分析发现,达格列净,empagliflozin,和sotagliflozin显着降低复合CV死亡/HFH,与主要分析一致。然而,从NMA中的头对头比较中没有发现显著差异.SUCRA表明,索格列净降低复合CV死亡/HFH的可能性最高(97.6%),其次是依帕格列净(58.4%)和达格列净(44.0%)。
■SGLT2显著降低了复合CV死亡/HFH结果。其中,canagliflozin可能被认为是糖尿病和心力衰竭史患者的首选治疗方法。但与其他SGLT2is相比,它也可能与任何不良事件的风险增加相关.然而,一项针对HF特异性试验的敏感性分析确定sotagliflozin是最有可能降低CV死亡/HFH的药物,其次是empagliflozin和dapagliflozin.
■https://www.crd.约克。AC.英国/普华永道/,标识符CRD42022353754。
UNASSIGNED: In patients with type 2 diabetes (T2D) and a history of heart failure (HF), sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated cardiovascular (CV) benefits. However, the comparative efficacy of individual SGLT2is remains uncertain. This network meta-analysis (NMA) compared the efficacy and safety of five SGLT2is (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and sotagliflozin) on CV outcomes in these patients.
UNASSIGNED: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to September 23, 2022, to identify all randomized controlled trials (RCTs) comparing SGLT2is to placebo in T2D patients with HF. The main outcomes included composite CV death/heart failure hospitalization (HFH), HFH, CV death, all-cause mortality, and adverse events. Pairwise and NMA approaches were applied.
UNASSIGNED: Our analysis included 11 RCTs with a total of 20,438 patients with T2D and HF. All SGLT2is significantly reduced HFH compared to standard of care (SoC) alone. \"Add-on\" SGLT2is, except ertugliflozin, significantly reduced composite CV death/HFH relative to SoC alone. Moreover, canagliflozin had lower composite CV death/HFH compared to dapagliflozin. Based on the surface under the cumulative ranking curve (SUCRA), the top-ranked SGLT2is for reducing HFH were canagliflozin (95.5%), sotagliflozin (66.0%), and empagliflozin (57.2%). Head-to-head comparisons found no significant differences between individual SGLT2is in reducing CV death. \"Add-on\" SGLT2is reduced all-cause mortality compared with SoC alone, although only dapagliflozin was statistically significant. No SGLT2is were significantly associated with serious adverse events. A sensitivity analysis focusing on HF-specific trials found that dapagliflozin, empagliflozin, and sotagliflozin significantly reduced composite CV death/HFH, consistent with the main analysis. However, no significant differences were identified from their head-to-head comparisons in the NMA. The SUCRA indicated that sotagliflozin had the highest probability of reducing composite CV death/HFH (97.6%), followed by empagliflozin (58.4%) and dapagliflozin (44.0%).
UNASSIGNED: SGLT2is significantly reduce the composite CV death/HFH outcome. Among them, canagliflozin may be considered the preferred treatment for patients with diabetes and a history of heart failure, but it may also be associated with an increased risk of any adverse events compared to other SGLT2is. However, a sensitivity analysis focusing on HF-specific trials identified sotagliflozin as the most likely agent to reduce CV death/HFH, followed by empagliflozin and dapagliflozin.
UNASSIGNED: https://www.crd.york.ac.uk/prospero/, identifier CRD42022353754.