Martínez-Vizcaíno Vicente, Díez-Fernández Ana, Álvarez-Bueno Celia, Martínez-Alfonso Julia, Cavero-Redondo Iván
Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.
Faculty of Health Sciences, Universidad Autónoma de Chile, Talca 3460000, Chile.
J Clin Med. 2021 Jun 19;10(12):2713. doi: 10.3390/jcm10122713.
To jointly assess the safety and effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on cardiorenal outcomes and all-cause mortality in type 2 diabetes mellitus (T2DM) with or at high risk of cardiovascular disease (CVD). We performed a systematic review and network meta-analysis, systematically searching the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science databases up to September 2020. Primary outcomes were composite major adverse cardiovascular events (MACEs), hospitalization for heart failure, all-cause mortality and a composite renal outcome. We performed a random effects network meta-analysis estimating the pooled hazard ratio (HR), risk ratio and number needed to treat (NNT). Six trials evaluating empagliflozin, canagliflozin, dapagliflozin and ertugliflozin met the inclusion/exclusion criteria, which comprised 46,969 patients, mostly with established CVD. Pooled estimates (95% CI) of benefits of SGLT2i in terms of HR and NNT were as follows: for all-cause mortality, 0.85 (0.75, 0.97) and 58 (28, 368); for MACE, 0.91 (0.85, 0.97) and 81 (44, 271); for hospitalization for heart failure, 0.70 (0.62, 0.78) and 32 (20, 55); and for composite renal outcome, 0.61 (0.50, 0.74) and 20 (11, 44). Pooled estimates for serious adverse events were 0.92 (95% CI 0.89, 0.95). In patients with T2DM at cardiovascular risk, ertugliflozin is a less potent drug than empagliflozin, canagliflozin or dapagliflozin to prevent cardiorenal events and all-cause mortality. In addition, our data endorse that empagliflozin is the best treatment option among SGLT2i for this type of patient, but the evidence is not consistent enough.
联合评估钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对伴有心血管疾病（CVD）或有CVD高风险的2型糖尿病（T2DM）患者心脏和肾脏结局以及全因死亡率的安全性和有效性。我们进行了一项系统评价和网状Meta分析，系统检索了截至2020年9月的MEDLINE、EMBASE、Cochrane对照试验中央注册库和科学网数据库。主要结局包括复合重大不良心血管事件（MACE）、因心力衰竭住院、全因死亡率和复合肾脏结局。我们进行了随机效应网状Meta分析，估计合并风险比（HR）、风险比和需治疗人数（NNT）。六项评估恩格列净、卡格列净、达格列净和依鲁格列净的试验符合纳入/排除标准，共纳入46969例患者，大多数患有已确诊的CVD。SGLT2i在HR和NNT方面的合并益处估计如下：全因死亡率方面，分别为0.85（0.75，0.97）和58（28，368）；MACE方面，分别为0.91（0.85，0.97）和81（44，271）；因心力衰竭住院方面，分别为0.70（0.62，0.78）和32（20，55）；复合肾脏结局方面，分别为0.61（0.50，0.74）和20（11，44）。严重不良事件的合并估计值为0.92（95%CI 0.89，0.95）。在有心血管风险的T2DM患者中，依鲁格列净在预防心脏和肾脏事件以及全因死亡率方面的效力低于恩格列净、卡格列净或达格列净。此外，我们的数据支持恩格列净是这类患者中SGLT2i的最佳治疗选择，但证据不够一致。
