Guan Ruifang, Yang Qing, Yang Xiaolei, Du Wandi, Li Xuening, Ma Guo
Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, China.
Department of Clinical Pharmacology, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Pharmacol. 2022 Oct 14;13:998816. doi: 10.3389/fphar.2022.998816. eCollection 2022.
In light of clinical trials comparing different doses of tirzepatide with selective glucagon-like peptide-1 receptor agonist (GLP1-RA) or insulin analogue, a bayesian network meta-analysis was conducted to investigate the efficacy and safety of tirzepatide in patients with type 2 diabetes mellitus (T2DM). We systematically searched PubMed, Embase, Web of science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to 2 May 2022. Final included studies met the eligibility criteria and methodological quality recommendations. Data analysis was performed using Stata 15.1 software. Each outcome was presented as a mean difference or an odds ratio, and the surface under the cumulative ranking curve value (SCURA). Ultimately, eight eligible RCTs involving 7245 patients were included. Generally speaking, compared with basal insulin (glargine or degludec); selective GLP1-RA (dulaglutide or semaglutide once weekly), 10 and 15 mg of tirzepatide exhibited better antidiabetic and weight-loss effect, especially, 15 mg of tirzepatide was dominant on reducing glycated hemoglobin (SCURA probability: 93.5%), body weight (99.7%), and fasting serum glucose (86.6%). As for safety, insulin caused less gastrointestinal events (93.5%), and there was no statistical difference between GLP1-RA and tirzepatide. Compare with insulin and GLP1-RA, tirzepatide display favorable efficacy and acceptable safety for T2DM patients. More well-designed RCTs are needed to evaluate its clinical performance with higher doses of GLP1-RA and determine its potential cardiovascular benefits.
鉴于比较不同剂量替尔泊肽与选择性胰高血糖素样肽-1受体激动剂（GLP1-RA）或胰岛素类似物的临床试验，进行了一项贝叶斯网络荟萃分析，以研究替尔泊肽在2型糖尿病（T2DM）患者中的疗效和安全性。我们系统地检索了PubMed、Embase、科学网、Cochrane对照试验中央注册库和ClinicalTrials.gov，检索时间从各数据库创建至2022年5月2日。最终纳入的研究符合纳入标准和方法学质量建议。使用Stata 15.1软件进行数据分析。每个结果以平均差或比值比以及累积排序曲线下面积值（SCURA）表示。最终，纳入了八项涉及7245例患者的合格随机对照试验（RCT）。一般来说，与基础胰岛素（甘精胰岛素或德谷胰岛素）、选择性GLP1-RA（度拉糖肽或司美格鲁肽每周一次）相比，10毫克和15毫克的替尔泊肽表现出更好的抗糖尿病和减肥效果，特别是15毫克的替尔泊肽在降低糖化血红蛋白（SCURA概率：93.5%）、体重（99.7%）和空腹血糖（86.6%）方面占优势。至于安全性，胰岛素引起的胃肠道事件较少（93.5%），GLP1-RA与替尔泊肽之间无统计学差异。与胰岛素和GLP1-RA相比，替尔泊肽对T2DM患者显示出良好的疗效和可接受的安全性。需要更多设计良好的RCT来评估其与更高剂量GLP1-RA的临床性能，并确定其潜在的心血管益处。
