Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Interdisciplinary Program in Medical Informatics, Seoul National University College of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2021 Apr;36(2):388-400. doi: 10.3803/EnM.2020.912. Epub 2021 Mar 31.
To compare the renal effects of dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors on individual outcomes in patients with type 2 diabetes.
We searched electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) from inception to June 2019 to identity eligible randomized controlled trials of DPP-4 inhibitors or SGLT2 inhibitors that reported at least one kidney outcome in patients with type 2 diabetes. Outcomes of interest were microalbuminuria, macroalbuminuria, worsening nephropathy, and end-stage kidney disease (ESKD). We performed an arm-based network meta-analysis using Bayesian methods and calculated absolute risks and rank probabilities of each treatment for the outcomes.
Seventeen studies with 87,263 patients were included. SGLT2 inhibitors significantly lowered the risks of individual kidney outcomes, including microalbuminuria (odds ratio [OR], 0.64; 95% credible interval [CrI], 0.41 to 0.93), macroalbuminuria (OR, 0.48; 95% CrI, 0.24 to 0.72), worsening nephropathy (OR, 0.65; 95% CrI, 0.44 to 0.91), and ESKD (OR, 0.65; 95% CrI, 0.46 to 0.98) as compared with placebo. However, DPP-4 inhibitors did not lower the risks. SGLT2 inhibitors were considerably associated with higher absolute risk reductions in all kidney outcomes than DPP-4 inhibitors, although the benefits were statistically insignificant. The rank probabilities showed that SGLT2 inhibitors were better treatments for lowering the risk of albuminuria and ESKD than placebo or DPP-4 inhibitors.
SGLT2 inhibitors were superior to DPP-4 inhibitors in reducing the risk of albuminuria and ESKD in patients with type 2 diabetes.
比较二肽基肽酶-4（DPP-4）抑制剂和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂对 2 型糖尿病患者个体结局的肾脏影响。
我们检索了电子数据库（MEDLINE、Embase 和 Cochrane 对照试验中心注册库），检索时间从建库至 2019 年 6 月，以确定纳入了至少有一项 2 型糖尿病患者肾脏结局的 DPP-4 抑制剂或 SGLT2 抑制剂的随机对照试验。感兴趣的结局为微量白蛋白尿、大量白蛋白尿、肾病恶化和终末期肾病（ESKD）。我们使用贝叶斯方法进行了基于手臂的网络荟萃分析，并计算了每种治疗方法的绝对风险和各治疗方法的排名概率。
纳入了 17 项研究，共计 87263 例患者。与安慰剂相比，SGLT2 抑制剂可显著降低各肾脏结局的风险，包括微量白蛋白尿（比值比 [OR]，0.64；95%可信区间 [CrI]，0.41 至 0.93）、大量白蛋白尿（OR，0.48；95% CrI，0.24 至 0.72）、肾病恶化（OR，0.65；95% CrI，0.44 至 0.91）和 ESKD（OR，0.65；95% CrI，0.46 至 0.98）。然而，DPP-4 抑制剂并没有降低风险。与 DPP-4 抑制剂相比，SGLT2 抑制剂在所有肾脏结局中都具有更大的绝对风险降低，但获益无统计学意义。排名概率表明，SGLT2 抑制剂在降低白蛋白尿和 ESKD 风险方面优于安慰剂或 DPP-4 抑制剂。
SGLT2 抑制剂在降低 2 型糖尿病患者的白蛋白尿和 ESKD 风险方面优于 DPP-4 抑制剂。
