新型抗糖尿病药物对复合肾脏结局的绝对治疗效果：数字化个体患者数据的荟萃分析

Absolute treatment effects of novel antidiabetic drugs on a composite renal outcome: meta-analysis of digitalized individual patient data.

作者信息

Brockmeyer Maximilian, Parco Claudio, Vargas Kris Gregory, Westenfeld Ralf, Jung Christian, Kelm Malte, Roden Michael, Akbulut Cihan, Schlesinger Sabrina, Wolff Georg, Kuss Oliver

机构信息

Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.

Nuffield Department of Population Health, University of Oxford, Oxford, UK.

出版信息

J Nephrol. 2024 Mar;37(2):309-321. doi: 10.1007/s40620-023-01858-8. Epub 2024 Jan 18.

DOI:10.1007/s40620-023-01858-8

PMID:38236473

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11043149/

Abstract

BACKGROUND

Absolute treatment benefits-expressed as numbers needed to treat-of the glucose lowering and cardiovascular drugs, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose transporter 2 (SGLT2) inhibitors on renal outcomes remain uncertain. With the present meta-analysis of digitalized individual patient data, we aimed to display and compare numbers needed to treat of both drugs on a composite renal outcome.

METHODS

From Kaplan-Meier plots of major cardiovascular outcome trials of GLP-1 receptor agonists and SGLT2 inhibitors vs. placebo, we digitalized individual patient time-to-event information on composite renal outcomes with WebPlotDigitizer 4.2; numbers needed to treat from individual cardiovascular outcome trials were estimated using parametric Weibull regression models and compared to original data. Random-effects meta-analysis generated meta-numbers needed to treat with 95% confidence intervals (CI).

RESULTS

Twelve cardiovascular outcome trials (three for GLP-1 receptor agonists, nine for SGLT2 inhibitors) comprising 90,865 participants were included. Eight trials were conducted in primary type 2 diabetes populations, two in a primary heart failure and two in a primary chronic kidney disease population. Mean estimated glomerular filtration rate at baseline ranged between 37.3 and 85.3 ml/min/1.73 m. Meta-analyses estimated meta-numbers needed to treat of 85 (95% CI 60; 145) for GLP-1 receptor agonists and 104 (95% CI 81; 147) for SGLT2 inhibitors for the composite renal outcome at the overall median follow-up time of 36 months.

CONCLUSION

The present meta-analysis of digitalized individual patient data revealed moderate and similar absolute treatment benefits of GLP-1 receptor agonists and SGLT2 inhibitors compared to placebo for a composite renal outcome.

摘要

背景

降糖药物和心血管药物，即胰高血糖素样肽-1（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，在肾脏结局方面的绝对治疗益处（以治疗所需人数表示）仍不确定。通过对数字化个体患者数据进行本次荟萃分析，我们旨在展示并比较这两种药物在复合肾脏结局方面的治疗所需人数。

方法

从GLP-1受体激动剂和SGLT2抑制剂与安慰剂对照的主要心血管结局试验的Kaplan-Meier曲线中，我们使用WebPlotDigitizer 4.2软件将个体患者复合肾脏结局的事件发生时间信息数字化；使用参数化威布尔回归模型估计个体心血管结局试验的治疗所需人数，并与原始数据进行比较。随机效应荟萃分析得出具有95%置信区间（CI）的荟萃治疗所需人数。

结果

纳入了12项心血管结局试验（3项针对GLP-1受体激动剂，9项针对SGLT2抑制剂），共90,865名参与者。8项试验在原发性2型糖尿病患者中进行，2项在原发性心力衰竭患者中进行，2项在原发性慢性肾脏病患者中进行。基线时平均估计肾小球滤过率在37.3至85.3 ml/min/1.73m²之间。荟萃分析估计，在36个月的总体中位随访时间时，GLP-1受体激动剂治疗复合肾脏结局的荟萃治疗所需人数为85（95%CI 60；145），SGLT2抑制剂为104（95%CI 81；147）。