Comparative efficacy of sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists in chronic kidney disease and type 2 diabetes: A systematic review and network meta-analysis.
Humans
Cardiovascular Diseases
/ epidemiology
Diabetes Mellitus, Type 2
/ complications
Glucagon-Like Peptide-1 Receptor
/ agonists
Glucose
/ therapeutic use
Hypoglycemic Agents
/ adverse effects
Mineralocorticoid Receptor Antagonists
/ adverse effects
Network Meta-Analysis
Renal Insufficiency, Chronic
/ complications
Sodium
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Symporters
/ therapeutic use
GLP-1 receptor agonists
SGLT-2 inhibitors
diabetic kidney disease
network meta-analysis
non-steroidal MRAs
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
04
02
2023
received:
02
11
2022
accepted:
04
02
2023
medline:
4
5
2023
pubmed:
9
2
2023
entrez:
8
2
2023
Statut:
ppublish
Résumé
To compare the relative efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and non-steroidal mineralocorticoid receptor antagonists (nsMRAs) in improving the cardiovascular and renal outcomes in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). We searched PubMed, Embase and Cochrane Library from inception through 25 November 2022. We selected randomized controlled trials that studied patients with CKD and T2D with a follow-up of at least 24 weeks and compared SGLT-2is, GLP-1RAs and nsMRAs with each other and with placebo. Primary outcomes were major adverse cardiovascular events (MACE) and composite renal outcomes (CRO). Secondary outcomes were cardiovascular death, all-cause death, stroke, myocardial infarction and heart failure hospitalization (HFH). A frequentist approach was used to pool risk ratios (RRs) with 95% confidence intervals (CIs). Twenty-nine studies with 50 938 participants for MACE and 49 965 participants for CRO were included. SGLT-2is did not significantly reduce MACE but were associated with significantly lower risks of CRO compared with GLP-1RAs (RR, 0.77; 95% CI, 0.64-0.91; P = .003) and nsMRAs (RR, 0.78; 95% CI, 0.68-0.90; P = .001). Compared with GLP-1RAs and nsMRAs, SGLT-2is significantly reduced risks of HFH by 31% (RR, 0.69; 95% CI, 0.55-0.88; P = .002) and 22% (RR, 0.78; 95% CI, 0.63-0.95; P = .016), respectively, but did not significantly reduce other secondary outcomes. There were no significant differences between GLP-1RAs and nsMRAs in lowering all outcomes. SGLT-2is were associated with better cardiorenal protection than GLP-1RAs and nsMRAs in patients with CKD and T2D.
Substances chimiques
Glucagon-Like Peptide-1 Receptor
0
Glucose
IY9XDZ35W2
Hypoglycemic Agents
0
Mineralocorticoid Receptor Antagonists
0
Sodium
9NEZ333N27
Sodium-Glucose Transporter 2 Inhibitors
0
Symporters
0
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1614-1623Informations de copyright
© 2023 John Wiley & Sons Ltd.
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