Michigan Medicine, Ann Arbor, MI, USA.
Ann Pharmacother. 2021 Apr;55(4):496-508. doi: 10.1177/1060028020951955. Epub 2020 Aug 14.
This systematic review describes the efficacy, safety, and drug interactions of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose transport protein 2 (SGLT2) inhibitors in kidney transplant recipients (KTRs).
Articles were identified by English-language MEDLINE search, published prior to May 2020, using the terms kidney transplant, OR PTDM, OR NODAT, AND metformin, OR DPP4, OR GLP1, OR SGLT2.
All selected studies were included if the study population was composed of adult KTRs who were diagnosed with either impaired glucose tolerance, diabetes mellitus (DM), new-onset diabetes after transplant (NODAT), or posttransplantation diabetes mellitus (PTDM).
In KTRs, there is evidence for safety with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors. However, urinary tract infections and a slight initial decrease in renal function may limit use of SGLT2 inhibitors. As compared with the nontransplant type 2 DM population, SGLT2 inhibitors are not as efficacious in KTRs.
This review provides an overview of the current literature on newer antidiabetic agents, addressing efficacy, safety, and drug interactions to help guide clinical decision-making for their use in KTRs.
Newer antidiabetic agents have been recommended by the American Diabetes Association for potential cardiovascular, renal, and hypoglycemic benefits. Particular agents, such as DPP-4 inhibitors and GLP-1 RAs may play a role in correcting PTDM-related defects. Clinicians need to take into account both patient-specific and drug-specific characteristics when initiating these agents in KTRs.
本系统综述描述了二肽基肽酶-4（DPP-4）抑制剂、胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂在肾移植受者（KTRs）中的疗效、安全性和药物相互作用。
通过英语 MEDLINE 搜索，使用术语肾移植、或 PTDM、或 NODAT、和二甲双胍、或 DPP4、或 GLP1、或 SGLT2，查找发表于 2020 年 5 月之前的文章，确定研究文献。
如果研究人群由患有糖耐量受损、糖尿病（DM）、移植后新发糖尿病（NODAT）或移植后糖尿病（PTDM）的成年 KTRs 组成，则所有选定的研究均包括在内。
在 KTRs 中，DPP-4 抑制剂、GLP-1 RAs 和 SGLT2 抑制剂的安全性有证据支持。然而，尿路感染和肾功能的轻微初始下降可能会限制 SGLT2 抑制剂的使用。与非移植 2 型糖尿病患者相比，SGLT2 抑制剂在 KTRs 中的疗效并不理想。
本综述提供了关于新型抗糖尿病药物的最新文献综述，探讨了疗效、安全性和药物相互作用，以帮助指导临床决策，为 KTRs 使用这些药物提供依据。
美国糖尿病协会推荐新型抗糖尿病药物具有潜在的心血管、肾脏和低血糖益处。特定的药物，如 DPP-4 抑制剂和 GLP-1 RAs，可能在纠正 PTDM 相关缺陷方面发挥作用。临床医生在 KTRs 中启动这些药物时，需要考虑患者的具体情况和药物的特点。
