Balijepalli Chakrapani, Shirali Rohan, Kandaswamy Prashanth, Ustyugova Anastasia, Pfarr Egon, Lund Søren S, Druyts Eric
Precision Health Economics, Vancouver, BC, Canada.
Boehringer Ingelheim GmbH, Ingelheim, Germany.
Diabetes Ther. 2018 Aug;9(4):1491-1500. doi: 10.1007/s13300-018-0456-7. Epub 2018 Jun 12.
Clinical trials conducted in patients with type 2 diabetes (T2DM) treated with glucose-lowering drugs and examining cardiovascular-related outcomes have yielded mixed results. In this work, we aimed to assess the relative treatment effects of empagliflozin versus sitagliptin and saxagliptin (dipeptidyl peptidase-4 (DPP-4) inhibitors) on cardiovascular-related outcomes in patients with T2DM.
We conducted a systematic literature review to identify clinical trials assessing cardiovascular-related outcomes for sitagliptin-, saxagliptin-, and empagliflozin-treated patients with T2DM. A network meta-analysis of indirect treatment comparisons was conducted in a Bayesian framework. Hazard ratios (HR) and 95% credible intervals (CrI) were computed for six cardiovascular-related outcomes to estimate the relative efficacies of these agents.
Empagliflozin showed a statistically significant superiority over saxagliptin (HR 0.60; 95% CrI 0.46-0.80) and sitagliptin (HR 0.60; 95% CrI 0.46-0.79) to reduce the risk for cardiovascular-related mortality. For all-cause mortality, empagliflozin showed a statistically significant risk reduction compared to saxagliptin (HR 0.61; 95% CrI 0.49-0.76) and sitagliptin (HR 0.67; 95% CrI 0.54-0.83). A similar pattern was observed in the risk reduction for hospitalization due to heart failure, where empagliflozin was found to be statistically significantly superior to saxagliptin (HR 0.51; 95% CrI 0.37-0.70) and sitagliptin (HR 0.65; 95% CrI 0.47-0.90). Empagliflozin was not statistically significantly different to sitagliptin and saxagliptin with regard to the risk of a composite endpoint composed of death, stroke or myocardial infarction.
In this indirect comparison to the DPP-4 inhibitors saxagliptin and sitagliptin, empagliflozin significantly lowered the risk of cardiovascular-related mortality, all-cause mortality and hospitalizations due to heart failure.
Boehringer Ingelheim GmbH.
在使用降糖药物治疗的2型糖尿病（T2DM）患者中进行的、考察心血管相关结局的临床试验结果不一。在本研究中，我们旨在评估恩格列净与西格列汀和沙格列汀（二肽基肽酶-4（DPP-4）抑制剂）相比，对T2DM患者心血管相关结局的相对治疗效果。
我们进行了一项系统文献综述，以确定评估西格列汀、沙格列汀和恩格列净治疗的T2DM患者心血管相关结局的临床试验。在贝叶斯框架下进行间接治疗比较的网状荟萃分析。计算六个心血管相关结局的风险比（HR）和95%可信区间（CrI），以估计这些药物的相对疗效。
在降低心血管相关死亡率方面，恩格列净显示出优于沙格列汀（HR 0.60；95% CrI 0.46 - 0.80）和西格列汀（HR 0.60；95% CrI 0.46 - 0.79）的统计学显著优势。在全因死亡率方面，与沙格列汀（HR 0.61；95% CrI 0.49 - 0.76）和西格列汀（HR 0.67；95% CrI 0.54 - 0.83）相比，恩格列净显示出统计学显著的风险降低。在因心力衰竭住院的风险降低方面也观察到类似模式，发现恩格列净在统计学上显著优于沙格列汀（HR 0.51；95% CrI 0.37 - 0.70）和西格列汀（HR 0.65；95% CrI 0.47 - 0.90）。在由死亡、中风或心肌梗死组成的复合终点风险方面，恩格列净与西格列汀和沙格列汀没有统计学显著差异。
在与DPP-4抑制剂沙格列汀和西格列汀的间接比较中，恩格列净显著降低了心血管相关死亡率、全因死亡率和因心力衰竭住院的风险。
勃林格殷格翰公司。
