利拉鲁肽与西他列汀联合二甲双胍治疗2型糖尿病患者的疗效和安全性：一项系统评价和荟萃分析。
Efficacy and safety of liraglutide versus sitagliptin both in combination with metformin in patients with type 2 diabetes: A systematic review and meta-analysis.
作者信息
Li Mingxing, Yang Yi, Jiang Deqi, Ying Miaofa, Wang Yong, Zhao Rui
机构信息
Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou Department of Biopharmaceutical, Yulin Normal University, Yulin Department of Pharmacy, Zhu Jiang Hospital, Southern Medical University, Guangzhou, China.
出版信息
Medicine (Baltimore). 2017 Sep;96(39):e8161. doi: 10.1097/MD.0000000000008161.
BACKGROUND
The aim of this systematic review was to evaluate the efficacy and safety of liraglutide versus sitagliptin both in combination with metformin in patients with type 2 diabetes and provide reference basis for rational use of clinical drugs.
METHODS
Several databases were searched, including Web of science, PubMed, Cochrane library, CNKI, and Wanfang database. Only randomized controlled trials (RCTs) of liraglutide versus sitagliptin both in combination with metformin up to 31 August 2016 were included. Data were extracted independently by 2 reviewers, and a fixed or random effects model were used to analyze outcomes that were expressed as odds ratio (OR) or mean difference (MD) and 95% confidence intervals (95% CIs) for different situations.
RESULTS
Five RCTs involving 1440 participants were included. Compared with sitagliptin combination with metformin group, participants' treatment with 1.2 mg and 1.8 mg liraglutide with metformin could significantly lower the level of glycosylated hemoglobin (HbA1c) (P < .00001, MD = -0.35, 95% CI -0.51 to -0.20). Moreover, patients with 1.8 mg liraglutide group had significant body weight loss (P < .00001, MD = -1.12, 95% CI -1.54 to -0.70). However, there were no obvious differences in cutting down the systolic blood pressure and diastolic blood pressure between liraglutide-metformin and sitagliptin-metformin groups. The incidence of gastrointestinal problems was significantly higher than sitagliptin with metformin groups.
CONCLUSION
The results of this meta-analysis indicated that Liraglutide added on to metformin therapy could significantly lower the level of HbA1c and increase body weight loss. Meanwhile, the adverse reactions such as gastrointestinal problems were common in the liraglutide treatment group. Thus, this will provide an important reference for the treatment of patients with type 2 diabetes.
背景
本系统评价旨在评估利拉鲁肽与西格列汀联合二甲双胍治疗2型糖尿病患者的疗效和安全性，为临床合理用药提供参考依据。
方法
检索了多个数据库，包括Web of science、PubMed、Cochrane图书馆、中国知网和万方数据库。纳入截至2016年8月31日的利拉鲁肽与西格列汀联合二甲双胍的随机对照试验（RCT）。由2名研究者独立提取数据，采用固定效应模型或随机效应模型分析结果，不同情况下结果以比值比（OR）或平均差（MD）及95%置信区间（95%CI）表示。
结果
纳入5项RCT，共1440例参与者。与西格列汀联合二甲双胍组相比，1.2mg和1.8mg利拉鲁肽联合二甲双胍治疗可显著降低糖化血红蛋白（HbA1c）水平（P<0.00001，MD=-0.35，95%CI -0.51至-0.20）。此外，1.8mg利拉鲁肽组患者体重显著减轻（P<0.00001，MD=-1.12，95%CI -1.54至-0.70）。然而，利拉鲁肽-二甲双胍组与西格列汀-二甲双胍组在降低收缩压和舒张压方面无明显差异。胃肠道问题的发生率显著高于西格列汀联合二甲双胍组。
结论
本荟萃分析结果表明，利拉鲁肽联合二甲双胍治疗可显著降低HbA1c水平并增加体重减轻。同时，利拉鲁肽治疗组胃肠道问题等不良反应较为常见。因此，这将为2型糖尿病患者的治疗提供重要参考。
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