Department of Medicine, Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India.
Department of Medicine, KPC Medical College & Hospital, Kolkata, West Bengal, India.
Endocr Pract. 2022 Aug;28(8):795-801. doi: 10.1016/j.eprac.2022.05.005. Epub 2022 May 13.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) in cardiovascular outcome trials (CVOTs) demonstrate cardiovascular (CV) safety and benefits. Some dedicated randomized controlled trials (RCTs) demonstrate benefit in terms of renal outcomes and hospitalization due to heart failure (HF). RCTs report differences in the secondary outcomes with respect to mortality (CV and/or all-cause). We undertook a meta-analysis of all SGLT2is for which in addition to CVOT, HF outcome/renal outcome studies are available to establish whether individual SGLT2is were able to prevent death.
We included available event-driven randomized, placebo-controlled CVOTs and dedicated RCTs of SGLT2is exploring renal outcomes and HF. We included 3 trials of empagliflozin, 3 of dapagliflozin, 2 of canagliflozin, and 2 of sotagliflozin. The efficacy outcomes included all-cause mortality and CV mortality. Hazard ratios (HRs) with 95% CIs were pooled for individual molecules.
The HR for all-cause mortality including all trials was 0.86 (0.80-0.93). The HRs for all-cause mortality in empagliflozin (N = 16 738), dapagliflozin (N = 26 208), canagliflozin (N = 14 543), and sotagliflozin (N = 11 806) were 0.86 (0.69-1.08), 0.83 (0.72-0.97), 0.86 (0.75-0.97), and 0.95 (0.81-1.11), respectively. The HR for CV mortality including all trials was 0.85 (0.78-0.92). The HRs for CV mortality in empagliflozin, dapagliflozin, sotagliflozin, and canagliflozin were 0.81 (0.63-1.03), 0.88 (0.78-1.00), 0.89 (0.74-1.07), and 0.84 (0.72-0.98), respectively.
SGLT2is as a class reduce both all-cause mortality and CV mortality. Canagliflozin possibly reduces both all-cause mortality and CV mortality, whereas dapagliflozin may reduce all-cause mortality but not CV mortality. Empagliflozin and sotagliflozin may reduce neither.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is）在心血管结局试验（CVOTs）中显示出心血管（CV）安全性和益处。一些专门的随机对照试验（RCTs）证明了在肾脏结局和心力衰竭（HF）住院方面的获益。RCT 报告了次要结局方面死亡率（CV 和/或全因）的差异。我们对所有 SGLT2is 进行了荟萃分析，这些 SGLT2is 除了 CVOT 外，还可获得心力衰竭/肾脏结局研究的结果，以确定个别 SGLT2is 是否能够预防死亡。
我们纳入了可用的事件驱动型随机、安慰剂对照的 SGLT2is CVOTs 和专门探索肾脏结局和 HF 的 RCTs。我们纳入了恩格列净的 3 项试验、达格列净的 3 项试验、卡格列净的 2 项试验和索格列净的 2 项试验。疗效结局包括全因死亡率和 CV 死亡率。个体分子的汇总风险比（HRs）及其 95%置信区间（CIs）。
包括所有试验在内的全因死亡率的 HR 为 0.86（0.80-0.93）。恩格列净（N=16738）、达格列净（N=26208）、卡格列净（N=14543）和索格列净（N=11806）的全因死亡率 HR 分别为 0.86（0.69-1.08）、0.83（0.72-0.97）、0.86（0.75-0.97）和 0.95（0.81-1.11）。包括所有试验在内的 CV 死亡率的 HR 为 0.85（0.78-0.92）。恩格列净、达格列净、索格列净和卡格列净的 CV 死亡率 HR 分别为 0.81（0.63-1.03）、0.88（0.78-1.00）、0.89（0.74-1.07）和 0.84（0.72-0.98）。
SGLT2is 作为一类药物可降低全因死亡率和 CV 死亡率。卡格列净可能降低全因死亡率和 CV 死亡率，而达格列净可能降低全因死亡率但不降低 CV 死亡率。恩格列净和索格列净可能都无法降低这两种死亡率。
