胰高血糖素样肽-1受体激动剂在射血分数保留或轻度降低的心力衰竭患者中的比较疗效：一项全面的贝叶斯网络荟萃分析和网络荟萃回归分析
Comparative Effectiveness of Glucagon-like Peptide-1- Receptor Agonists in Patients With Heart Failure With Preserved or Minimally Reduced Ejection Fraction: A Comprehensive Bayesian Network Meta-Analysis and Network Meta-Regression.
作者信息
Khalil Ibrahim, Islam M Rafiqul, Kamrul-Hasan A B M, Nagendra Lakshmi, Promi Sunjida Amin, Sayed Md Abu, Rahman Mohd Turzo, Sultana Nowrin, Tasmi Noshin Anjum, Das Manisha, Tarannum Salsabil, Dey Rajendronath, Dutta Deep
机构信息
Department of Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
Department of Internal Medicine, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh.
出版信息
Endocr Pract. 2025 Sep;31(9):1133-1142. doi: 10.1016/j.eprac.2025.06.005. Epub 2025 Jun 18.
OBJECTIVES
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown beneficial effects on clinical outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) or minimally reduced ejection fraction (HFmrEF). This network meta-analysis (NMA) aimed to consolidate evidence from RCTs assessing the effects of GLP-1 RAs in HFpEF and HF with reduced ejection fraction.
METHODS
Several databases were searched comprehensively for relevant RCTs. A Bayesian NMA was conducted using R, and meta-regression was employed to investigate potential sources of heterogeneity. Statistical significance was evaluated using 95% credible intervals (CrIs) and surface under the cumulative ranking curve to rank treatment effectiveness. The primary outcome was hospitalization for HF (HHF).
RESULTS
Eight reports from 6 Phase 3 RCTs (N = 24 099), mostly with low risks of bias, were included. Compared to placebo, semaglutide reduced the risk of HHF (HR 0.52, 95% CrI [0.25, 0.87]), while tirzepatide (HR 0.51, 95% CrI [0.16, 1.24]) and exenatide (HR 0.82, 95% CrI [0.33, 1.73]) demonstrated no effect. Semaglutide and exenatide, but not tirzepatide, reduced the risk of all-cause mortality. None affected cardiovascular mortality. Semaglutide decreased the risk of worsening of HF events; tirzepatide did not. Tirzepatide and semaglutide enabled weight loss; however, only semaglutide notably enhanced the 6-minute walk distance. According to the surface under the cumulative ranking curve values, tirzepatide ranked highest for reducing HHF and body weight, semaglutide for decreasing cardiovascular mortality and worsening of HF events and improving the 6-minute walk distance, and exenatide for reducing all-cause mortality.
CONCLUSION
GLP-1 RAs provide significant benefits for patients with HFpEF or HFmrEF, with semaglutide offering more advantages than tirzepatide and exenatide.
目的
胰高血糖素样肽-1受体激动剂（GLP-1 RAs）已显示出对射血分数保留的心力衰竭（HFpEF）或轻度射血分数降低的心力衰竭（HFmrEF）患者的临床结局具有有益影响。这项网络荟萃分析（NMA）旨在整合随机对照试验（RCT）的证据，以评估GLP-1 RAs对HFpEF和射血分数降低的心力衰竭的影响。
方法
全面检索了多个数据库以查找相关的随机对照试验。使用R进行贝叶斯网络荟萃分析，并采用荟萃回归来研究异质性的潜在来源。使用95%可信区间（CrIs）和累积排名曲线下的面积来评估治疗效果的统计学显著性。主要结局是因心力衰竭住院（HHF）。
结果
纳入了6项3期随机对照试验的8份报告（N = 24099），大多数偏倚风险较低。与安慰剂相比，司美格鲁肽降低了HHF风险（风险比[HR] 0.52，95%可信区间[CrI] [0.25, 0.87]），而替尔泊肽（HR 0.51, 95% CrI [0.16, 1.24]）和艾塞那肽（HR 0.82, 95% CrI [0.33,
1.73]）未显示出效果。司美格鲁肽和艾塞那肽降低了全因死亡率，但替尔泊肽未降低。均未影响心血管死亡率。司美格鲁肽降低了心力衰竭事件恶化的风险；替尔泊肽未降低。替尔泊肽和司美格鲁肽可导致体重减轻；然而，只有司美格鲁肽显著增加了6分钟步行距离。根据累积排名曲线下的面积值，替尔泊肽在降低HHF和体重方面排名最高，司美格鲁肽在降低心血管死亡率和心力衰竭事件恶化以及改善6分钟步行距离方面排名最高，艾塞那肽在降低全因死亡率方面排名最高。
结论
GLP-1 RAs为HFpEF或HFmrEF患者带来显著益处，司美格鲁肽比替尔泊肽和艾塞那肽具有更多优势。
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