基于肠促胰岛素的治疗药物（包括替尔泊肽）对2型糖尿病患者肾脏结局的影响：一项系统评价和荟萃分析。

Effects of incretin-based therapeutic agents including tirzepatide on renal outcomes in patients with type 2 diabetes: A systemic review and meta-analysis.

作者信息

Mima Akira, Gotoda Hidemasa, Lee Rina, Murakami Ami, Akai Ryosuke, Lee Shinji

机构信息

Department of Nephrology, Osaka Medical and Pharmaceutical University, Osaka, Japan.

出版信息

Metabol Open. 2023 Feb 24;17:100236. doi: 10.1016/j.metop.2023.100236. eCollection 2023 Mar.

BACKGROUND

This meta-analysis was conducted to investigate the effects of incretin-based therapeutic agents, including the latest agent tirzepatide, on renal outcomes in patients with type 2 diabetes.

METHODS

MEDLINE (via PubMed) and Cochrane databases were searched for studies involving incretin-based therapeutic agents up to July 2022. Randomized and controlled trials comparing incretin-based therapeutic agents with placebo or other antidiabetic agents, and reporting renal outcomes were selected. The inclusion criteria were items related to the effects on albuminuria and the kidney-specific composite outcomes. A network meta-analysis was conducted to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Twelve trials consisting of 75,346 participants were included in this meta-analysis. Glucagon-like peptide-1 (GLP-1) receptor agonists reduced the risk of the kidney-specific composite outcome by 21% (HR 0.79, 95% CI 0.75-0.85), and worsening albuminuria by 24% (HR 0.76, 95% CI 0.71-0.82). In particular, the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist tirzepatide remarkably reduced the risk of the kidney-specific composite outcome by 45% (HR 0.55, 95% CI 0.40-0.77), and worsening albuminuria by 62% (HR 0.38, 95% CI 0.24-0.61).

CONCLUSIONS

Among incretin-based therapeutic agents, tirzepatide was associated with a significantly reduced risk of diabetic kidney disease.

背景

本荟萃分析旨在研究基于肠促胰岛素的治疗药物，包括最新药物替尔泊肽，对2型糖尿病患者肾脏结局的影响。

方法

检索MEDLINE（通过PubMed）和Cochrane数据库，查找截至2022年7月涉及基于肠促胰岛素的治疗药物的研究。选择将基于肠促胰岛素的治疗药物与安慰剂或其他抗糖尿病药物进行比较并报告肾脏结局的随机对照试验。纳入标准为与对蛋白尿和肾脏特异性复合结局的影响相关的项目。进行网络荟萃分析以计算风险比（HR）和95%置信区间（CI）。

结果

本荟萃分析纳入了12项试验，共75346名参与者。胰高血糖素样肽-1（GLP-1）受体激动剂使肾脏特异性复合结局的风险降低了21%（HR 0.79，95%CI 0.75-0.85），蛋白尿恶化风险降低了24%（HR 0.76，95%CI 0.71-0.82）。特别是，双重葡萄糖依赖性促胰岛素多肽（GIP）/GLP-1受体激动剂替尔泊肽使肾脏特异性复合结局的风险显著降低了45%（HR 0.55，95%CI 0.40-0.77），蛋白尿恶化风险降低了62%（HR 0.38，95%CI 0.24-0.61）。