School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong, China.
School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
Adv Ther. 2021 Mar;38(3):1470-1482. doi: 10.1007/s12325-021-01637-6. Epub 2021 Feb 13.
The present study aimed to evaluate the effects of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on clinical and safety outcomes including glycemic control and cardiometabolic indicators using network meta-analysis.
MEDLINE, Embase, and Cochrane Library Central Register of Controlled Trials were searched from inception through June 30, 2019. Randomized clinical trials comparing one or more of six eligible GLP-1RAs with placebo or another eligible GLP-1RA were identified. We further screened studies that had 24-30 week follow-up periods and target endpoints. The primary outcome was change in hemoglobin A (HbA). Secondary outcomes included additional glycemic control indicators, cardiometabolic measures, and adverse events. Frequentist random-effect network meta-analyses were conducted for effect comparison.
The NMA synthesized evidence from 54 studies covering 23,209 patients and 18 GLP-1RA regimens. All included GLP-1RA regimens except liraglutide 0.3 mg once weekly (QW) significantly lowered HbA after 24-30 weeks compared with placebo. The pairwise comparison of HbA-lowering effect showed that dulaglutide 0.75 mg QW, dulaglutide 1.5 mg QW, exenatide 2 mg QW, liraglutide 0.9 mg QW, liraglutide 1.2 mg QW, liraglutide 1.8 mg QW, loxenatide 100 µg QW, and loxenatide 200 µg QW were not significantly outperformed by any of the other regimens. The effects on blood pressure, weight, and lipids were relatively mixed. The GLP-1RA regimens had comparable safety profiles with regard to hypoglycemia and adverse events.
Regimens of GLP-1RAs had differential glycemic control and cardiometabolic effectiveness. Policymaking and patient-centric clinical decisions should take into consideration the comparative effectiveness profiles.
本研究旨在通过网络荟萃分析评估胰高血糖素样肽 1 受体激动剂（GLP-1RAs）在包括血糖控制和心血管代谢指标在内的临床和安全性结局方面的效果。
从建库至 2019 年 6 月 30 日，检索 MEDLINE、Embase 和 Cochrane 图书馆对照试验中心注册库。确定了比较一种或多种符合条件的 GLP-1RAs 与安慰剂或另一种符合条件的 GLP-1RA 的随机临床试验。我们进一步筛选了具有 24-30 周随访期和目标终点的研究。主要结局为血红蛋白 A（HbA）的变化。次要结局包括其他血糖控制指标、心血管代谢指标和不良事件。采用固定效应网络荟萃分析进行效果比较。
NMA 综合了来自 54 项研究的证据，涵盖了 23209 名患者和 18 种 GLP-1RA 方案。与安慰剂相比，所有纳入的 GLP-1RA 方案（除了每周一次 0.3mg 利拉鲁肽）在 24-30 周后均显著降低 HbA。HbA 降低效果的两两比较显示，每周一次 0.75mg 度拉糖肽、每周一次 1.5mg 度拉糖肽、每周一次 2mg 艾塞那肽、每周一次 0.9mg 利拉鲁肽、每周一次 1.2mg 利拉鲁肽、每周一次 1.8mg 利拉鲁肽、每周一次 100µg 洛塞那肽和每周一次 200µg 洛塞那肽与其他任何方案相比均无显著优势。对血压、体重和血脂的影响则相对混杂。GLP-1RA 方案在低血糖和不良事件方面具有相似的安全性特征。
GLP-1RA 方案在血糖控制和心血管代谢方面具有不同的效果。政策制定和以患者为中心的临床决策应考虑到比较效果特征。
