恩格列净与二肽基肽酶-4（DPP-4）抑制剂治疗2型糖尿病的心血管安全性：系统文献综述与间接比较
Cardiovascular Safety of Empagliflozin Versus Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Type 2 Diabetes: Systematic Literature Review and Indirect Comparisons.
作者信息
Balijepalli Chakrapani, Shirali Rohan, Kandaswamy Prashanth, Ustyugova Anastasia, Pfarr Egon, Lund Søren S, Druyts Eric
机构信息
Precision Health Economics, Vancouver, BC, Canada.
Boehringer Ingelheim GmbH, Ingelheim, Germany.
出版信息
Diabetes Ther. 2018 Aug;9(4):1491-1500. doi: 10.1007/s13300-018-0456-7. Epub 2018 Jun 12.
INTRODUCTION
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
FUNDING
Boehringer Ingelheim GmbH.
引言
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。
方法
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。
结果
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。
结论
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。
资助
勃林格殷格翰公司。
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