网络荟萃分析比较非奈利酮与 SGLT2 抑制剂和 GLP-1 受体激动剂对 2 型糖尿病合并慢性肾脏病患者心血管和肾脏结局的影响。

Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease.

机构信息

Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.

Section II of Endocrinology & Nephropathy Department of Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Beijing, China.

出版信息

Cardiovasc Diabetol. 2022 Nov 5;21(1):232. doi: 10.1186/s12933-022-01676-5.

OBJECTIVE

To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis.

METHODS

Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI).

RESULTS

18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR [95% CI]; 0.88 [0.80-0.97], 0.86 [0.79-0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95% CI]; 0.84 [0.78-0.90]), renal outcome (RR [95% CI]; 0.67 [0.60-0.74], HHF (RR [95% CI]; 0.60 [0.53-0.68]), all-cause death (ACD) (RR [95% CI]; 0.89 [0.81-0.91]) and cardiovascular death (CVD) (RR [95% CI]; 0.86 [0.77-0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95% CI]; 0.86 [0.78-0.94]). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95% CI]; 1.29 [1.13-1.47], 1.31 [1.07-1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95% CI]; 1.36 [1.16-1.59], 1.49 [1.18-1.89], respectively) in renal outcome and HHF.

CONCLUSIONS

In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues.

目的

通过网络荟萃分析评估在患有 2 型糖尿病（T2DM）和慢性肾病（CKD）的患者中，非奈利酮、钠-葡萄糖共转运蛋白-2 抑制剂（SGLT2i）和胰高血糖素样肽-1 受体激动剂（GLP-1RA）的心血管和肾脏获益。

方法

系统检索了 PubMed、Cochrane 图书馆、Web of Science、Medline 和 Embase，检索时间为 2000 年 1 月 1 日至 2021 年 12 月 30 日。选择了比较非奈利酮、SGLT-2i 和 GLP-1RA 在患有 CKD 的糖尿病患者中的随机对照试验（RCT）。我们进行了网络荟萃分析，以间接比较这两种药物和非奈利酮。结果以风险比（RR）及其相应的 95%置信区间（CI）报告。

结果

纳入了 18 项涉及 51496 名患者的 RCT。非奈利酮降低了主要不良心血管事件（MACE）、肾脏结局和心力衰竭住院（HHF）的风险（RR[95%CI]；0.88[0.80-0.97]、0.86[0.79-0.93]、0.79[0.67,0.92]，分别）。SGLT-2i 与 MACE（RR[95%CI]；0.84[0.78-0.90]）、肾脏结局（RR[95%CI]；0.67[0.60-0.74]）、HHF（RR[95%CI]；0.60[0.53-0.68]）、全因死亡（ACD）（RR[95%CI]；0.89[0.81-0.91]）和心血管死亡（CVD）（RR[95%CI]；0.86[0.77-0.96]）的风险降低相关，与安慰剂相比。GLP-1RA 与 MACE（RR[95%CI]；0.86[0.78-0.94]）的风险降低相关。SGLT2i 与非奈利酮（非奈利酮与 SGLT2i：RR[95%CI]；1.29[1.13-1.47]、1.31[1.07-1.61]，分别）和 GLP-1RA（GLP-1RA 与 SGLT2i：RR[95%CI]；1.36[1.16-1.59]、1.49[1.18-1.89]，分别）在肾脏结局和 HHF 方面的疗效有显著差异。

结论

在患有 T2DM 和 CKD 的患者中，SGLT2i、GLP-1RA 和非奈利酮在 MACE、ACD 和 CVD 方面相似。SGLT2i 与非奈利酮和 GLP-1RA 相比，显著降低了肾脏事件和 HHF 的风险。在 GLP-1RA 中，GLP-1 类似物在降低心血管事件方面的效果明显优于 exendin-4 类似物。