Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China.
BMJ Open. 2023 Mar 7;13(3):e061807. doi: 10.1136/bmjopen-2022-061807.
To compare the efficacy and safety between and within glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT-2is) in overweight or obese adults with or without diabetes mellitus.
PubMed, ISI Web of Science, Embase and Cochrane Central Register of Controlled Trials database were comprehensively searched to identify randomised controlled trials (RCTs) of effects of GLP-1RAs and SGLT-2is in overweight or obese participants from inception to 16 January 2022. The efficacy outcomes were the changes of body weight, glucose level and blood pressure. The safety outcomes were serious adverse events and discontinuation due to adverse events. The mean differences, ORs, 95% credible intervals (95% CI), the surface under the cumulative ranking were evaluated for each outcome by network meta-analysis.
Sixty-one RCTs were included in our analysis. Both GLP-1RAs and SGLT-2is conferred greater extents in body weight reduction, achieving at least 5% wt loss, HbA1c and fasting plasma glucose decrease compared with placebo. GLP-1RAs was superior to SGLT-2is in HbA1c reduction (MD: -0.39%, 95% CI -0.70 to -0.08). GLP-1RAs had high risk of adverse events, while SGLT-2is were relatively safe. Based on intraclass comparison, semaglutide 2.4 mg was among the most effective interventions in losing body weight (MD: -11.51 kg, 95% CI -12.83 to -10.21), decreasing HbA1c (MD: -1.49%, 95% CI -2.07 to -0.92) and fasting plasma glucose (MD: -2.15 mmol/L, 95% CI -2.83 to -1.59), reducing systolic blood pressure (MD: -4.89 mm Hg, 95% CI -6.04 to -3.71) and diastolic blood pressure (MD: -1.59 mm Hg, 95% CI -2.37 to -0.86) with moderate certainty evidences, while it was associated with high risk of adverse events.
Semaglutide 2.4 mg showed the greatest effects on losing body weight, controlling glycaemic level and reducing blood pressure while it was associated with high risk of adverse events.PROSPERO registration numberCRD42021258103.
比较超重或肥胖伴或不伴糖尿病成人中胰高血糖素样肽-1 受体激动剂（GLP-1RA）和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）的疗效和安全性。
全面检索 PubMed、ISI Web of Science、Embase 和 Cochrane 对照试验中心注册数据库，以确定截至 2022 年 1 月 16 日 GLP-1RA 和 SGLT-2i 对超重或肥胖参与者影响的随机对照试验（RCT）。疗效结局为体重、血糖和血压的变化。安全性结局为严重不良事件和因不良事件而停药。通过网状荟萃分析评估每个结局的均值差、OR、95%可信区间（95%CI）、累积排序曲线下面积。
纳入 61 项 RCT 进行分析。与安慰剂相比，GLP-1RA 和 SGLT-2i 均可更显著地减轻体重，达到至少 5%wt 减轻、HbA1c 和空腹血糖降低。GLP-1RA 在降低 HbA1c 方面优于 SGLT-2i（MD：-0.39%，95%CI：-0.70 至 -0.08）。GLP-1RA 不良事件风险较高，而 SGLT-2i 相对安全。基于类内比较，司美格鲁肽 2.4mg 是减重最有效的干预措施之一（MD：-11.51kg，95%CI：-12.83 至 -10.21），降低 HbA1c（MD：-1.49%，95%CI：-2.07 至 -0.92）和空腹血糖（MD：-2.15mmol/L，95%CI：-2.83 至 -1.59），降低收缩压（MD：-4.89mmHg，95%CI：-6.04 至 -3.71）和舒张压（MD：-1.59mmHg，95%CI：-2.37 至 -0.86），具有中等确定性证据，但与高不良事件风险相关。
司美格鲁肽 2.4mg 在减重、控制血糖水平和降低血压方面效果最好，但与高不良事件风险相关。
PROSPERO 注册号：CRD42021258103。
