Weill Cornell Medicine Qatar, Doha, Qatar.
Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.
J Diabetes Complications. 2017 Sep;31(9):1458-1464. doi: 10.1016/j.jdiacomp.2017.05.016. Epub 2017 Jun 3.
Dipeptidyl peptidase-4 (DPP-4) inhibitors improve glycemic control in patients with type 2 diabetes mellitus. There are also reports of an effect of these drugs in reducing inflammation through inhibition of tumor necrosis factor-α (TNF-α) that is an important mediator for several inflammatory processes. The present systematic review and meta-analysis were performed to evaluate the effect of DPP-4 inhibitors on circulating TNF-α levels in T2DM patients.
A systematic review and a meta-analysis were undertaken on all controlled trials of DPP-4 inhibitors that included measurement of TNF-α. The search included PubMed-Medline, Scopus, ISI Web of Knowledge and Google Scholar databases. Quantitative data synthesis was performed using a random-effects model, with standardized mean difference (SMD) and 95% confidence interval (CI) as summary statistics. Meta-regression and leave-one-out sensitivity analysis were performed to assess the modifiers of treatment response.
Eight eligible articles (6 with sitagliptin and 2 with vildagliptin) comprising 9 treatment arms were selected for this meta-analysis. Meta-analysis suggested a significant reduction of circulating TNF-α concentrations following treatment with DPP-4 inhibitors (SMD: -1.84, 95% CI: -2.88, -0.80, p=0.001). The effect size was robust in the sensitivity analysis and not mainly driven by a single study. A subgroup analysis did not suggest any significant difference between the TNF-α-lowering activity of sitagliptin (SMD: -1.49, 95% CI: -2.89, -0.10) and vildagliptin (SMD: -2.80, 95% CI: -4.98, -0.61) (p=0.326).
This meta-analysis of the 8 available controlled trials showed that DPP-4 inhibition in patients with type 2 diabetes mellitus was associated with significant reductions in plasma TNF-α levels with no apparent difference between sitagliptin and vildagliptin.
二肽基肽酶-4（DPP-4）抑制剂可改善 2 型糖尿病患者的血糖控制。也有报道称，这些药物通过抑制肿瘤坏死因子-α（TNF-α）发挥作用，TNF-α 是多种炎症过程的重要介质。本系统评价和荟萃分析旨在评估 DPP-4 抑制剂对 2 型糖尿病患者循环 TNF-α 水平的影响。
对所有包含 TNF-α 测量的 DPP-4 抑制剂对照试验进行了系统评价和荟萃分析。检索了 PubMed-Medline、Scopus、ISI Web of Knowledge 和 Google Scholar 数据库。使用随机效应模型进行定量数据合成，以标准化均数差（SMD）和 95%置信区间（CI）作为汇总统计量。进行了荟萃回归和逐一剔除敏感性分析，以评估治疗反应的修饰剂。
纳入了这项荟萃分析的 8 篇合格文章（6 篇使用西他列汀，2 篇使用维达列汀）包括 9 个治疗组。荟萃分析表明，DPP-4 抑制剂治疗后循环 TNF-α 浓度显著降低（SMD：-1.84，95%CI：-2.88，-0.80，p=0.001）。敏感性分析结果表明，该效应大小稳健，且不受单个研究的影响。亚组分析表明，西他列汀（SMD：-1.49，95%CI：-2.89，-0.10）和维达列汀（SMD：-2.80，95%CI：-4.98，-0.61）降低 TNF-α 活性之间没有显著差异（p=0.326）。
对 8 项现有对照试验的荟萃分析表明，2 型糖尿病患者的 DPP-4 抑制与血浆 TNF-α 水平显著降低相关，西他列汀和维达列汀之间没有明显差异。
