Precision Xtract, Vancouver, British Columbia, Canada.
Novo Nordisk A/S, Søborg, Denmark.
BMJ Open. 2019 Jul 23;9(7):e023458. doi: 10.1136/bmjopen-2018-023458.
To determine the comparative efficacy of once-weekly semaglutide relative to sodium-glucose cotransporter 2 inhibitors (SGLT-2is) licensed in Europe and North America among patients with type 2 diabetes (T2D) inadequately controlled with 1-2 oral antidiabetics (OADs), using a network meta-analysis (NMA). Design systematic review and network meta-analysis. Data Sources EMBASE, MEDLINE and CENTRAL were searched from January 1994 to August 2017.
Randomised controlled trials with ≥20 weeks of treatment evaluating once-weekly semaglutide or SGLT-2is. Primary outcomes included change from baseline in: HbA1c, weight, systolic blood pressure, postprandial blood glucose and fasting plasma glucose. Fixed-effect and random-effect Bayesian NMA were used to indirectly compare treatment effects at 26 (±4) weeks. Metaregression and sensitivity analyses were conducted. Model selection was performed using the deviance information criterion and consistency was assessed by comparing indirect (edge-splitting) to direct evidence.
Forty-eight publications representing 21 trials were included. The mean differences (MD) in change from baseline in HbA1c of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from -0.56% for canagliflozin 300 mg (95% credible interval (CrI): -0.76 to -0.33%), to -0.95% for dapagliflozin 5 mg (95% CrI: -1.20 to -0.69%). The MD in change from baseline in weight of once-weekly semaglutide 1.0 mg versus SGLT-2is ranged from -1.35 kg for canagliflozin 300 mg to -2.48 kg for dapagliflozin 5 mg, while change from baseline in fasting plasma glucose ranged from -0.41 mmol/L for canagliflozin 300 mg to -1.37 mmol/L for dapagliflozin 5 mg. Once-weekly semaglutide was not statistically differentiable than all SGLT-2is in reducing systolic blood pressure. NMA was not feasible for postprandial blood glucose and safety outcomes.
Once-weekly semaglutide demonstrated statistically significant and clinically meaningful reductions in HbA1c and body weight in T2D patients inadequately controlled with 1-2 OADs compared to all SGLT-2is licensed in Europe and North America.
通过网络荟萃分析（NMA），比较每周一次的司美格鲁肽相对于欧洲和北美的钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）在 1-2 种口服降糖药（OAD）控制不佳的 2 型糖尿病（T2D）患者中的疗效。
系统综述和网络荟萃分析。
从 1994 年 1 月至 2017 年 8 月，检索了 EMBASE、MEDLINE 和 CENTRAL 数据库。
纳入了 20 周以上治疗期的随机对照试验，评估了每周一次的司美格鲁肽或 SGLT-2i 的疗效。主要结局包括从基线HbA1c、体重、收缩压、餐后血糖和空腹血糖的变化。采用固定效应和随机效应贝叶斯 NMA 间接比较 26（±4）周时的治疗效果。进行了荟萃回归和敏感性分析。使用偏差信息准则进行模型选择，并通过比较直接（边缘分裂）和间接证据来评估一致性。
共纳入 48 项研究，涉及 21 项试验。每周一次的司美格鲁肽 1.0 mg 与 SGLT-2i 相比，HbA1c 从基线的平均差值（MD）范围为卡格列净 300 mg 的-0.56%（95%可信区间（CrI）：-0.76 至-0.33%）至达格列净 5 mg 的-0.95%（95%CrI：-1.20 至-0.69%）。每周一次的司美格鲁肽 1.0 mg 与 SGLT-2i 相比，体重从基线的平均差值范围为卡格列净 300 mg 的-1.35 kg 至达格列净 5 mg 的-2.48 kg，而空腹血糖从基线的平均差值范围为卡格列净 300 mg 的-0.41 mmol/L 至达格列净 5 mg 的-1.37 mmol/L。每周一次的司美格鲁肽与所有 SGLT-2i 相比，在降低收缩压方面无统计学差异。餐后血糖和安全性结局的 NMA 不可行。
与欧洲和北美的所有 SGLT-2i 相比，每周一次的司美格鲁肽在 1-2 种 OAD 控制不佳的 T2D 患者中，可显著降低 HbA1c 和体重，具有统计学意义和临床意义。
