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新型降糖药物的心血管安全性分析

[Analysis of cardiovascular safety of novel glucose-lowering medications].

作者信息

Mkrtumyan A M, Markova T N, Mishchenko N K

机构信息

A. I. Yevdokimov Moscow State University of Medicine and Dentistry.

A. I. Yevdokimov Moscow State University of Medicine and Dentistry; City Clinical Hospital №52, Moscow.

出版信息

Kardiologiia. 2019 Jul 19;59(7):76-83. doi: 10.18087/cardio.2019.7.10267.

Abstract

In 2008 the Food and Drug Administration has revised approval process for new antidiabetic agents and introduced a requirement to demonstrate the cardiovascular safety in an international multicenter trial. Currently cardiovascular outcome trials of dipeptidyl peptidase-4 (DPP-4) inhibitors (SAVOR-TIMI53, EXAMINE and TECOS), sodium-glucose cotransporter 2 inhibitors (EMPAREG, CANVAS), glucagon-like peptide-1 receptor agonists (ELIXA, EXSCEL LEADER and SUSTAIN-6), ultralong-acting and insulin (DEVOTE) have been completed. The trials confirmed cardiovascular safety of these glucose-lowering medications, and in addition, EMPA-REG OUTCOME (empagliflozin), CANVAS (canagliflozin) and LEADER (liraglutide) have also demonstrated cardioprotective effect of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. These data led to the changes of clinical guidelines for the management of type 2 diabetes.

摘要

2008年,美国食品药品监督管理局修订了新型抗糖尿病药物的审批流程,并提出在国际多中心试验中证明心血管安全性的要求。目前,二肽基肽酶-4(DPP-4)抑制剂(SAVOR-TIMI53、EXAMINE和TECOS)、钠-葡萄糖协同转运蛋白2抑制剂(EMPAREG、CANVAS)、胰高血糖素样肽-1受体激动剂(ELIXA、EXSCEL、LEADER和SUSTAIN-6)以及超长效胰岛素(DEVOTE)的心血管结局试验已经完成。这些试验证实了这些降糖药物的心血管安全性,此外,EMPA-REG OUTCOME(恩格列净)、CANVAS(卡格列净)和LEADER(利拉鲁肽)还证明了钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂的心脏保护作用。这些数据导致了2型糖尿病管理临床指南的改变。

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