比较 2 型糖尿病儿童和青少年降糖药物的疗效和安全性：系统评价和网络荟萃分析。
Comparative efficacy and safety of glucose-lowering drugs in children and adolescents with type 2 diabetes: A systematic review and network meta-analysis.
机构信息
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China.
出版信息
Front Endocrinol (Lausanne). 2022 Aug 11;13:897776. doi: 10.3389/fendo.2022.897776. eCollection 2022.
OBJECTIVE
Type 2 diabetes is more common in adults, but is becoming the major concern in children and adolescent recently. This study aimed to provide additional pharmaceutical management for children and adolescents with type 2 diabetes by assessing the efficacy and safety of several glucose-lowering drugs.
METHODS
Searches were performed in PubMed, Medline, Ovid, Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov that reported the efficacy and safety of drugs for children and adolescents with type 2 diabetes. Pooled effects were calculated by frequentist fixed effects network meta-analyses and additive network meta-analyses.
RESULTS
A total of 12 trials assessing eight glucose-lowering drugs were included, which compose of seven trials with monotherapy and five trials with combination therapies. Network meta-analysis results showed compared to placebo, saxagliptin+metformin (mean difference (MD) -1.91% [-2.85%, -0.97%]), liraglutide+metformin (MD -1.45% [-1.65%, -1.26%]), and liraglutide (MD -0.90% [-1.35%, -0.45%]) were the top 3 drugs that significantly reduced hemoglobin A1c (HbA1c). Sitagliptin+metformin, dapagliflozin, exenatide-2mcg, linagliptin-5mg, metformin, exenatide-5/10mcg, glimepiride, and sitagliptin also showed significant reduction in HbA1c. There were no significant differences between treatments in the incidence of adverse events, except that liraglutide+metformin had significant adverse effect such as abdominal pain. In addition, dapagliflozin, sitagliptin+metformin, and saxagliptin+metformin showed better efficacy compared with FDA-approved drugs.
CONCLUSIONS
The top 10 treatments of type 2 diabetes in children and adolescents aged 10-17 years were saxagliptin+metformin, liraglutide+metformin, liraglutide, dapagliflozin, exenatide-2 mcg, sitagliptin+metformin, linagliptin-5 mg, linagliptin-1 mg, metformin, and exenatide-5/10 mcg.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284897, identifier CRD42021284897.
目的
2 型糖尿病在成年人中更为常见，但最近它已成为儿童和青少年的主要关注点。本研究旨在通过评估几种降血糖药物的疗效和安全性，为 2 型糖尿病儿童和青少年提供额外的药物治疗选择。
方法
在 PubMed、Medline、Ovid、Cochrane 对照试验注册中心（CENTRAL）和 ClinicalTrials.gov 中进行了检索，检索内容为报告儿童和青少年 2 型糖尿病药物疗效和安全性的研究。使用固定效应网络荟萃分析和加法网络荟萃分析计算汇总效应。
结果
共纳入 12 项评估 8 种降血糖药物的试验，其中包括 7 项单药治疗试验和 5 项联合治疗试验。网络荟萃分析结果显示，与安慰剂相比，沙格列汀+二甲双胍（平均差值（MD）-1.91%[-2.85%，-0.97%]）、利拉鲁肽+二甲双胍（MD-1.45%[-1.65%，-1.26%]）和利拉鲁肽（MD-0.90%[-1.35%，-0.45%]）是降低糖化血红蛋白（HbA1c）最有效的 3 种药物。西格列汀+二甲双胍、达格列净、艾塞那肽-2mcg、利格列汀-5mg、二甲双胍、艾塞那肽-5/10mcg、格列美脲和西格列汀也显著降低了 HbA1c。除利拉鲁肽+二甲双胍有腹痛等不良反应外，各治疗组间不良反应发生率无显著差异。此外，达格列净、西格列汀+二甲双胍和沙格列汀+二甲双胍的疗效优于 FDA 批准的药物。
结论
10-17 岁儿童和青少年 2 型糖尿病的前 10 种治疗方法为沙格列汀+二甲双胍、利拉鲁肽+二甲双胍、利拉鲁肽、达格列净、艾塞那肽-2 mcg、西格列汀+二甲双胍、利格列汀-5mg、利格列汀-1mg、二甲双胍和艾塞那肽-5/10 mcg。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284897，标识符 CRD42021284897。
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