Dalui Saikat K, Chakraverty Raja, Yasmin Nafisha, Pattanaik Smita, Pandit Kaushik, Chatterjee Suparna
Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Endocrinol Metab. 2021 Jul-Aug;25(4):283-292. doi: 10.4103/ijem.ijem_237_21. Epub 2021 Dec 15.
This meta-analysis of randomized clinical trials (RCT) intends to evaluate the efficacy of DPP4 Inhibitors (DPP4I) compared with placebo, other antidiabetics (or DPP4I) on renal outcomes, adverse events (AEs), and all-cause mortality.
We searched relevant scientific database for RCTs with DPP4I and prespecified renal end point. The effect size (mean difference or risk ratio) was reported with its 95% confidence interval.
Eight RCTs ( = 39040 participants) were included in the analysis. The rate of change in eGFR was not different in DPP4 inhibitor and control group. DPP4I use beyond 52 weeks did not worsen albuminuria progression (RR 0.88; 95% CI 0.80 to 0.96; high quality evidence) compared to placebo. The risk of AEs within 52 weeks (RR 0.93; 95% CI 0.80 to 1.08; moderate quality evidence), beyond 52 weeks (RR 0.98; 95% CI 0.97 to 1.00; low quality evidence), and all-cause mortality (RR 1.04; 95% CI 0.96 to 1.12; very low quality evidence) were similar to placebo. In head-to-head comparison between two DPP4I studies, no significant differences were found between alogliptin and vildagliptin for improvement in eGFR, UACR, or AE at 24 weeks.
DPP4I do not seem to provide persuasive benefit in the renal outcomes or all-cause mortality in diabetes mellitus, though there was no evidence for increased AEs.
本随机临床试验（RCT）的荟萃分析旨在评估二肽基肽酶4抑制剂（DPP4I）与安慰剂、其他抗糖尿病药物（或DPP4I）相比，在肾脏结局、不良事件（AE）和全因死亡率方面的疗效。
我们在相关科学数据库中检索了有DPP4I和预先设定的肾脏终点的RCT。效应量（平均差或风险比）及其95%置信区间被报告。
八项RCT（n = 39040名参与者）被纳入分析。DPP4抑制剂组和对照组的估算肾小球滤过率（eGFR）变化率没有差异。与安慰剂相比，使用DPP4I超过52周并未使蛋白尿进展恶化（风险比0.88；95%置信区间0.80至0.96；高质量证据）。52周内（风险比0.93；95%置信区间0.80至1.08；中等质量证据）、52周后（风险比0.98；95%置信区间0.97至1.00；低质量证据）的不良事件风险以及全因死亡率（风险比1.04；95%置信区间0.96至1.12；极低质量证据）与安慰剂相似。在两项DPP4I研究的直接比较中，阿格列汀和维格列汀在24周时改善eGFR、尿白蛋白肌酐比值（UACR）或不良事件方面未发现显著差异。
DPP4I在糖尿病的肾脏结局或全因死亡率方面似乎没有提供有说服力的益处，尽管没有证据表明不良事件增加。
