Shi Zepeng, Gao Feng, Liu Wei, He Xuezhi
Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, Dalian, China.
Front Cardiovasc Med. 2022 Apr 4;9:869272. doi: 10.3389/fcvm.2022.869272. eCollection 2022.
The efficacy of dapagliflozin and empagliflozin in sodium-glucose cotransport-2 inhibitors (SGLT-2i) in patients with heart failure (HF) has been discovered. However, which drug could improve varied prognostic outcomes has not been elucidated. Hence, we compared their efficacies on the prognostic improvement of HF.
Databases including PubMed, EMBASE, Scopus, Google Scholars, and the Cochrane Library were searched for all related randomized controlled trials (RCTs) published from inception to 13 October 2021. Network meta-analyses were performed to generate matrices to show the effect size for pairwise comparison regarding all the interventions.
Eventually a total of 11 RCTs were included in this study. For the primary endpoints, dapagliflozin was comparable with empagliflozin in hospitalization for HF, and empagliflozin (OR=0.70, 95%CI: 0.59-0.84) decreased the risk of exacerbation of HF over dapagliflozin. For the secondary endpoints, dapagliflozin was comparable with empagliflozin in cardiovascular (CV) death /hospitalization for HF, and for CV death, dapagliflozin (OR=0.78, 95%CI: 0.65-0.92) significantly reduced mortality over the placebo. For the tertiary endpoints, dapagliflozin (OR=0.80, 95%CI: 0.66-0.98) significantly decreased the mortality over empagliflozin in all-cause death, and neither drug significantly increased the risk of hypoglycemia.
Overall, 10 mg/day dapagliflozin may be the optimal recommendation for its premium and comprehensive effect on improving the prognosis of patients with HF compared to 10 mg/day empagliflozin.
已发现达格列净和恩格列净在心力衰竭（HF）患者中作为钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）的疗效。然而，哪种药物能改善不同的预后结果尚未阐明。因此，我们比较了它们对HF预后改善的疗效。
检索包括PubMed、EMBASE、Scopus、谷歌学术和Cochrane图书馆在内的数据库，以查找从开始到2021年10月13日发表的所有相关随机对照试验（RCT）。进行网络荟萃分析以生成矩阵，以显示所有干预措施两两比较的效应大小。
最终本研究共纳入11项RCT。对于主要终点，达格列净在HF住院方面与恩格列净相当，而恩格列净（OR=0.70，95%CI：0.59-0.84）降低HF恶化风险的效果优于达格列净。对于次要终点，达格列净在心血管（CV）死亡/HF住院方面与恩格列净相当，对于CV死亡，达格列净（OR=0.78，95%CI：0.65-0.92）显著降低死亡率，优于安慰剂。对于三级终点，达格列净（OR=0.80，95%CI：0.66-0.98）在全因死亡方面显著降低死亡率，优于恩格列净，且两种药物均未显著增加低血糖风险。
总体而言，与10mg/天的恩格列净相比，10mg/天的达格列净在改善HF患者预后方面具有更好的综合效果，可能是最佳推荐。
