Tsukamoto Shunichiro, Morita Ryutaro, Yamada Takayuki, Urate Shingo, Azushima Kengo, Uneda Kazushi, Kobayashi Ryu, Kanaoka Tomohiko, Wakui Hiromichi, Tamura Kouichi
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Diabetes Res Clin Pract. 2022 Dec;194:110161. doi: 10.1016/j.diabres.2022.110161. Epub 2022 Nov 17.
Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular (CV) event in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, little evidence pertains to the benefits of their combined use.
We systematically searched the PubMed, MEDLINE, EMBASE, and Cochrane Library databases through July 2022. We selected randomized controlled trials comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination therapy, with placebo in patients with T2D and CKD. We performed a network meta-analysis to indirectly compare the treatments. The primary outcome was a composite of CV events.
Eight studies were selected with 36,186 patients. The primary outcome was significantly improved in the combination therapy group compared with the other groups (RR [95% CI]; vs SGLT-2 inhibitors, 0.76 [0.60; 0.96]; vs MRAs, 0.66 [0.53; 0.82]; vs placebo, 0.58 [0.47; 0.73]). Additionally, the combination therapy was associated with a considerable reduction in the risk of hyperkalemia (RR vs MRA, 0.43 [0.23; 0.79]).
Combination of SGLT-2 inhibitors and MRAs potentially reduced CV events compared with SGLT-2 inhibitors or MRAs alone. This combination may be a candidate treatment strategy for patients with T2D and CKD.
钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂和盐皮质激素受体拮抗剂（MRA）均已被证明可降低2型糖尿病（T2D）和慢性肾脏病（CKD）患者的心血管（CV）事件。然而，关于它们联合使用的益处的证据很少。
我们系统检索了截至2022年7月的PubMed、MEDLINE、EMBASE和Cochrane图书馆数据库。我们选择了比较SGLT-2抑制剂、MRA或SGLT-2抑制剂+MRA联合治疗与安慰剂在T2D和CKD患者中的随机对照试验。我们进行了网络荟萃分析以间接比较这些治疗方法。主要结局是CV事件的复合指标。
共纳入8项研究，36186例患者。与其他组相比，联合治疗组的主要结局有显著改善（RR [95% CI]；与SGLT-2抑制剂相比，0.76 [0.60；0.96]；与MRA相比，0.66 [0.53；0.82]；与安慰剂相比，0.58 [0.47；0.73]）。此外，联合治疗与高钾血症风险的显著降低相关（与MRA相比，RR为0.43 [0.23；0.79]）。
与单独使用SGLT-2抑制剂或MRA相比，SGLT-2抑制剂和MRA联合使用可能降低CV事件。这种联合治疗可能是T2D和CKD患者的一种候选治疗策略。
