磺酰脲类药物的死亡率风险：系统评价和网络荟萃分析。
Mortality risk among sulfonylureas: a systematic review and network meta-analysis.
机构信息
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.
出版信息
Lancet Diabetes Endocrinol. 2015 Jan;3(1):43-51. doi: 10.1016/S2213-8587(14)70213-X. Epub 2014 Oct 22.
BACKGROUND
Sulfonylureas are common second-line options for management of type 2 diabetes; however, they are associated with a higher risk of cardiovascular events compared with other antidiabetic drugs. Since tissue selectivity and risk of hypoglycaemia differ among sulfonylureas, we aimed to assess whether mortality and the risk of cardiovascular events also varies.
METHODS
We searched Medline and Embase from inception to June 11, 2014, to identify controlled studies reporting the risk of all-cause mortality, cardiovascular-related mortality, or myocardial infarction for at least two sulfonylureas. We examined differences in cardiovascular event risk among sulfonylureas with random effects models for direct pairwise comparisons and network meta-analyses to incorporate direct and indirect data.
FINDINGS
14 970 (9%) of 167 327 patients in 18 studies died: 841 (4%) of 19 334 gliclazide users, 5482 (11%) of 49 389 glimepiride users, 2106 (15%) of 14 464 glipizide users, 5296 (7%) of 77 169 glibenclamide users, 1066 (17%) of 6187 tolbutamide users, and 179 (23%) of 784 chlorpropamide users. Inconsistency was low for the network meta-analysis of all-cause mortality, and the relative risk of death compared with glibenclamide was 0·65 (95% credible interval 0·53-0·79) for gliclazide, 0·83 (0·68-1·00) for glimepiride, 0·98 (0·80-1·19) for glipizide, 1·13 (0·90-1·42) for tolbutamide, and 1·34 (0·98-1·86) for chlorpropamide. Similar associations were noted for cardiovascular-related mortality: the relative risk compared with glibenclamide was 0·60 (95% credible interval 0·45-0·84) for gliclazide, 0·79 (0·57-1·11) for glimepiride, 1·01 (0·72-1·43) for glipizide, 1·11 (0·79-1·55) for tolbutamide, and 1·45 (0·88-2·44) for chlorpropamide.
INTERPRETATION
Gliclazide and glimepiride were associated with a lower risk of all-cause and cardiovascular-related mortality compared with glibenclamide. Clinicians should consider possible differences in risk of mortality when selecting a sulfonylurea.
FUNDING
None.
背景
磺酰脲类药物是治疗 2 型糖尿病的常用二线选择，但与其他抗糖尿病药物相比，它们与心血管事件的风险增加有关。由于磺酰脲类药物的组织选择性和低血糖风险不同，我们旨在评估死亡率和心血管事件风险是否也有所不同。
方法
我们从 2014 年 6 月 11 日开始在 Medline 和 Embase 上进行搜索，以确定至少有两项磺酰脲类药物报告全因死亡率、心血管相关死亡率或心肌梗死风险的对照研究。我们使用随机效应模型检查了磺酰脲类药物之间的心血管事件风险差异，以便直接进行两两比较和网络荟萃分析，以纳入直接和间接数据。
结果
在 18 项研究中，有 14970 名（9%）167327 名患者死亡：19334 名格列齐特使用者中有 841 名（4%），49389 名格列美脲使用者中有 5482 名（11%），14464 名格列吡嗪使用者中有 2106 名（15%），77169 名格列本脲使用者中有 5296 名（7%），6187 名甲苯磺丁脲使用者中有 1066 名（17%），784 名氯磺丙脲使用者中有 179 名（23%）。全因死亡率的网络荟萃分析一致性较低，与格列本脲相比，格列齐特的死亡相对风险为 0.65（95%可信区间 0.53-0.79），格列美脲为 0.83（0.68-1.00），格列吡嗪为 0.98（0.80-1.19），甲苯磺丁脲为 1.13（0.90-1.42），氯磺丙脲为 1.34（0.98-1.86）。心血管相关死亡率也存在类似的关联：与格列本脲相比，格列齐特的相对风险为 0.60（95%可信区间 0.45-0.84），格列美脲为 0.79（0.57-1.11），格列吡嗪为 1.01（0.72-1.43），甲苯磺丁脲为 1.11（0.79-1.55），氯磺丙脲为 1.45（0.88-2.44）。
结论
与格列本脲相比，格列齐特和格列美脲与全因和心血管相关死亡率的风险降低相关。临床医生在选择磺酰脲类药物时应考虑到死亡率风险的可能差异。
资助
无。
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