比较每日和每周使用胰高血糖素样肽-1 受体激动剂治疗非酒精性脂肪性肝病和 2 型糖尿病患者的长期疗效：一项网络荟萃分析。

Comparing the effectiveness of long-term use of daily and weekly glucagon-like peptide-1 receptor agonists treatments in patients with nonalcoholic fatty liver disease and type 2 diabetes mellitus: a network meta-analysis.

机构信息

Department of Internal Medicine, Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China.

Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China.

出版信息

Front Endocrinol (Lausanne). 2023 Jun 5;14:1170881. doi: 10.3389/fendo.2023.1170881. eCollection 2023.

DOI:10.3389/fendo.2023.1170881

PMID:37342259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10277636/

Abstract

OBJECTIVE

In the present network meta-analysis (NMA), we aimed to compare the effectiveness of daily and weekly treatment with glucagon-like peptide-1 receptor agonists for patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM).

METHOD

We used Stata 17.0 for the NMA. Eligible Randomized controlled trials (RCTs) were searched in PubMed, Cochrane, and Embase databases until December 2022. Two researchers independently screened the available studies. The Cochrane Risk of Bias tool was used to assess the risk of bias in the included studies. We used GRADEprofiler (version3.6) to analyze the evidence certainty. Primary outcomes such as liver fat content (LFC), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, as well as secondary outcomes such as γ-glutamyltransferase (γGGT) and body weight, were evaluated. Then, each intervention was ranked by the surface under the cumulative ranking curve (SUCRA). As a supplement, we drew forest plots of subgroup using RevMan (version 5.4).

RESULTS

Fourteen RCTs involving 1666 participants were included in the present study. The NMA results showed that exenatide (bid) was the best treatment for improving LFC compared with other agents, liraglutide, dulaglutide, semaglutide (qw) and placebo), and the SUCRA values were 66.8%. Among five interventions (except exenatide (bid) and semaglutide (qw)) evaluated for AST outcome, and six interventions (except exenatide (bid)) evaluated for ALT outcome, semaglutide (qd) was the most effective drug (SUCRA (AST) = 100%, SUCRA (ALT) = 95.6%). The result of LFC in daily group was MD = -3.66, 95% CI [-5.56, -1.76] and in weekly GLP-1RAs group, it was MD = -3.51, 95% CI [-4, -3.02]. As to AST and ALT, the results in daily group versus weekly group were AST: MD = -7.45, 95% CI [-14.57, -0.32] versus MD= -0.58, 95% CI [-3.18, 2.01] and ALT: MD = -11.12, 95% CI [-24.18, 1.95] versus MD = -5.62, 95% CI [-15.25, 4]. The quality of evidence was assessed as moderate or low.

CONCLUSION

The daily GLP-1RAs may be more effective in primary outcomes. And the daily semaglutide may be the most effective treatment for NAFLD and T2DM among the six interventions.

摘要

目的

在本次网状荟萃分析（NMA）中，我们旨在比较每日和每周使用胰高血糖素样肽-1 受体激动剂（GLP-1RA）治疗非酒精性脂肪性肝病（NAFLD）合并 2 型糖尿病（T2DM）患者的疗效。

方法

我们使用 Stata 17.0 进行 NMA。检索 PubMed、Cochrane 和 Embase 数据库，以获取截至 2022 年 12 月的合格随机对照试验（RCT）。两位研究人员独立筛选了可用的研究。使用 Cochrane 偏倚风险工具评估纳入研究的偏倚风险。我们使用 GRADEprofiler（版本 3.6）分析证据确定性。评估了主要结局，如肝脂肪含量（LFC）、天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平，以及次要结局，如γ-谷氨酰转移酶（γGGT）和体重。然后，通过累积排序曲线下面积（SUCRA）对每种干预措施进行排名。作为补充，我们使用 RevMan（版本 5.4）绘制了亚组的森林图。

结果

本研究纳入了 14 项 RCT，涉及 1666 名参与者。NMA 结果显示，与其他药物（利拉鲁肽、度拉糖肽、司美格鲁肽（qw）和安慰剂）相比，艾塞那肽（bid）是改善 LFC 的最佳治疗方法，其 SUCRA 值为 66.8%。在评估 AST 结局的 5 种干预措施（除艾塞那肽（bid）和司美格鲁肽（qw）外）和评估 ALT 结局的 6 种干预措施（除艾塞那肽（bid）外）中，司美格鲁肽（qd）是最有效的药物（AST 的 SUCRA 值=100%，ALT 的 SUCRA 值=95.6%）。每日组的 LFC 结果为 MD = -3.66，95%CI [-5.56，-1.76]，每周 GLP-1RA 组为 MD = -3.51，95%CI [-4，-3.02]。至于 AST 和 ALT，每日组与每周组的结果为 AST：MD = -7.45，95%CI [-14.57，-0.32] 与 MD = -0.58，95%CI [-3.18，2.01] 和 ALT：MD = -11.12，95%CI [-24.18，1.95] 与 MD = -5.62，95%CI [-15.25，4]。证据质量被评估为中度或低度。