当前位置: X-MOL 学术Circulation › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Cardiovascular, Kidney, and Safety Outcomes With GLP-1 Receptor Agonists Alone and in Combination With SGLT2 Inhibitors in Type 2 Diabetes: A Systematic Review and Meta-Analysis.
Circulation ( IF 35.5 ) Pub Date : 2024-08-30 , DOI: 10.1161/circulationaha.124.071689
Brendon L Neuen 1 , Robert A Fletcher 2 , Lauren Heath 3 , Adam Perkovic 3 , Muthiah Vaduganathan 4 , Sunil Badve 5 , Katherine R Tuttle 6 , Richard Pratley 7 , Hertzel C Gerstein 8 , Vlado Perkovic 9 , Hiddo J L Heerspink 10
Affiliation  

BACKGROUND GLP-1 (glucagon-like peptide-1) receptor agonists and SGLT2 (sodium-glucose cotransporter 2) inhibitors both improve cardiovascular and kidney outcomes in people with type 2 diabetes. We conducted a systematic review and meta-analysis to assess the effects of GLP-1 receptor agonists on clinical outcomes with and without SGLT2 inhibitors. METHODS We searched MEDLINE and Embase databases from inception until July 12, 2024, for randomized, double-blind, placebo-controlled outcome trials of GLP-1 receptor agonists in type 2 diabetes that reported treatment effects by baseline use of SGLT2 inhibitors, with findings supplemented by unpublished data. We estimated treatment effects by baseline SGLT2 inhibitor use using inverse variance-weighted meta-analysis. The main cardiovascular outcomes were major adverse cardiovascular events (nonfatal myocardial infarction, stroke, or cardiovascular death) and hospitalization for heart failure. Kidney outcomes included a composite of ≥50% reduction in estimated glomerular filtration rate, kidney failure or death caused by kidney failure, and annualized rate of decline in estimated glomerular filtration rate (estimated glomerular filtration rate slope). Serious adverse events and severe hypoglycemia were also evaluated. This meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024565765). RESULTS We identified 3 trials with 1743 of 17 072 (10.2%) participants with type 2 diabetes receiving an SGLT2 inhibitor at baseline. GLP-1 receptor agonists reduced the risk of major adverse cardiovascular events by 21% (hazard ratio [HR], 0.79 [95% CI, 0.71-0.87]), with consistent effects in those receiving and not receiving SGLT2 inhibitors at baseline (HR, 0.77 [95% CI, 0.54-1.09] and HR, 0.79 [95% CI, 0.71-0.87], respectively; P-heterogeneity=0.78). The effect on hospitalization for heart failure was similarly consistent regardless of SGLT2 inhibitor use (HR, 0.58 [95% CI, 0.36-0.93] and HR, 0.73 [95% CI, 0.63-0.85]; P-heterogeneity=0.26). Effects on the composite kidney outcome (risk ratio, 0.79 [95% CI, 0.66-0.95]) and estimated glomerular filtration rate slope (0.78 mL/min/1.73 m2/y [95% CI, 0.57-0.98]) also did not vary according to SGLT2 inhibitor use (P-heterogeneity=0.53 and 0.94, respectively). Serious adverse effects and severe hypoglycemia were also similar regardless of SGLT2 inhibitor use (P-heterogeneity=0.29 and 0.50, respectively). CONCLUSIONS In people with type 2 diabetes, the cardiovascular and kidney benefits of GLP-1 receptor agonists are consistent regardless of SGLT2 inhibitor use.

中文翻译:


GLP-1 受体激动剂单独使用和与 SGLT2 抑制剂联合治疗 2 型糖尿病的心血管、肾脏和安全性结果:系统评价和荟萃分析。



背景 GLP-1 (胰高血糖素样肽-1) 受体激动剂和 SGLT2 (钠-葡萄糖协同转运蛋白 2) 抑制剂均可改善 2 型糖尿病患者的心血管和肾脏预后。我们进行了一项系统评价和荟萃分析,以评估 GLP-1 受体激动剂对有和没有 SGLT2 抑制剂的临床结局的影响。方法 我们检索了从建库到 2024 年 7 月 12 日的 MEDLINE 和 Embase 数据库,以查找 GLP-1 受体激动剂在 2 型糖尿病中的随机、双盲、安慰剂对照结局试验,这些试验报告了基线使用 SGLT2 抑制剂的治疗效果,并补充了未发表的数据。我们使用逆方差加权荟萃分析通过基线 SGLT2 抑制剂的使用来估计治疗效果。主要心血管结局是主要不良心血管事件 (非致死性心肌梗死、卒中或心血管死亡) 和心力衰竭住院治疗。肾脏结局包括估计肾小球滤过率降低 ≥50%、肾衰竭或肾衰竭导致的死亡,以及估计肾小球滤过率的年化下降率(估计肾小球滤过率斜率)。还评估了严重不良事件和严重低血糖。该荟萃分析已在国际前瞻性系统综述注册库 (PROSPERO;CRD42024565765)。结果: 我们确定了 3 项试验,其中 17 072 名 2 型糖尿病参与者中有 1743 名 (10.2%) 在基线时接受 SGLT2 抑制剂治疗。GLP-1 受体激动剂将主要不良心血管事件的风险降低了 21% (风险比 [HR],0.79 [95% CI,0.71-0.87]),对基线时接受和未接受 SGLT2 抑制剂的患者具有一致的效果 (HR,0.77 [95% CI,0.54-1。09] 和 HR,分别为 0.79 [95% CI,0.71-0.87];P-异质性 = 0.78)。无论是否使用 SGLT2 抑制剂,对心力衰竭住院治疗的影响都同样一致 (HR,0.58 [95% CI,0.36-0.93] 和 HR,0.73 [95% CI,0.63-0.85];P-异质性 = 0.26)。对复合肾脏结局 (风险比,0.79 [95% CI,0.66-0.95])和估计肾小球滤过率斜率 (0.78 mL/min/1.73 m2/y [95% CI,0.57-0.98])的影响也未因 SGLT2 抑制剂的使用而变化 (P-异质性 = 0.53 和 0.94,分别为)。无论使用 SGLT2 抑制剂,严重不良反应和严重低血糖也相似 (P-异质性分别为 = 0.29 和 0.50)。结论在 2 型糖尿病患者中,无论是否使用 SGLT2 抑制剂,GLP-1 受体激动剂的心血管和肾脏益处都是一致的。
更新日期:2024-08-30
down
wechat
bug