Equation AB, Halmstad, Sweden.
Dallas Diabetes Research Center at Medical City, Dallas, Texas, USA.
Clin Pharmacol Ther. 2019 May;105(5):1213-1223. doi: 10.1002/cpt.1307. Epub 2019 Jan 13.
Model-based meta-analysis was used to compare glycemic control, weight changes, and hypoglycemia risk across 24 antihyperglycemic drugs used to treat type 2 diabetes. Electronic searches identified 229 randomized controlled studies comprising 121,914 patients. To ensure fair and unbiased treatment comparisons, the analyses adjusted for important differences between studies, including duration of treatment, baseline glycated hemoglobin, and drug dosages. At the approved doses, glycemic control was typically greatest with glucagon-like peptide 1 receptor agonists (GLP-1RAs), and least with dipeptidyl peptidase-4 (DPP-4) inhibitors. Weight loss was highly variable across GLP-1RAs but was similar across sodium-glucose cotransporter 2 (SGLT2) inhibitors. Large weight increases were observed with sulfonylureas and thiazolidinediones. Hypoglycemia risk was highest with sulfonylureas, although gliclazide was notably lower. Hypoglycemia risk for DPP-4 inhibitors, SGLT2 inhibitors, and thiazolidinediones was generally very low but increased slightly for both GLP-1RAs and metformin. In summary, important differences between and within drug classes were identified.
采用基于模型的荟萃分析比较了 24 种用于治疗 2 型糖尿病的抗高血糖药物的血糖控制、体重变化和低血糖风险。电子检索确定了包含 121914 名患者的 229 项随机对照研究。为确保公平和无偏见的治疗比较，分析调整了研究之间的重要差异，包括治疗持续时间、基线糖化血红蛋白和药物剂量。在批准的剂量下，GLP-1 受体激动剂 (GLP-1RAs) 的血糖控制通常最佳，二肽基肽酶-4 (DPP-4) 抑制剂的控制效果最差。GLP-1RAs 之间的体重减轻差异很大，但钠-葡萄糖共转运蛋白 2 (SGLT2) 抑制剂之间的体重减轻差异相似。磺酰脲类药物和噻唑烷二酮类药物会导致体重显著增加。磺酰脲类药物的低血糖风险最高，尽管格列齐特明显较低。尽管 DPP-4 抑制剂、SGLT2 抑制剂和噻唑烷二酮类药物的低血糖风险通常非常低，但 GLP-1RAs 和二甲双胍的低血糖风险略有增加。总之，确定了药物类别之间和内部的重要差异。
