Network meta-analysis of nine large cardiovascular outcome trials of new antidiabetic drugs

Alfayez, Osamah M.; Yami, Majed S. Al; Alshibani, Mohannad; Fallatah, Saad; Khushaym, Nasser Mubarak Al; Alsheikh, Razan; Alkhatib, Nimer S.

doi:10.1016/j.pcd.2019.01.003

Cited by 16 publications

(17 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to the absence of CVOTs comparing GLP1RAs and SGLT2is, the relative efficacy of these two drug classes on cardiorenal endpoints is not given in the ADA and EASD consensus report ( 27 ). Thus, several network meta-analyses ( 1 , 28 , 29 ) including Lin et al's network meta-analysis ( 1 ) tried to derive the estimators of their relative cardiorenal efficacy by incorporating the indirect evidence from placebo-controlled CVOTs of GLP1RAs and those of SGLT2is. However, the different characteristics of those CVOTs included in the network meta-analyses ( 1 , 28 , 29 ) considerably weakened the credibility of the indirect evidence regarding the relative cardiorenal efficacy of GLP1RAs and SGLT2is.…”

Section: Discussionmentioning

confidence: 99%

SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

Qiu

Xu-bin

Wei

2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Lin et al. recently did a network meta-analysis based on cardiovascular (CV) outcome trials (CVOTs) of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and those of glucagon-like peptide-1 receptor agonists (GLP1RAs). Due to the absence of CVOTs directly comparing SGLT2is with GLP1RAs, Lin et al.'s network meta-analysis identified the indirect evidence that SGLT2is vs. GLP1RAs reduced hospitalization for heart failure (HHF) but did not reduce CV death and all-cause mortality (ACM) in patients with type 2 diabetes (T2D). We did another meta-analysis incorporating those CV outcome cohort studies directly comparing SGLT2is with GLP1RAs, and identified that SGLT2is vs. GLP1RAs were significantly associated with the lower risks of not only HHF but also CV death and ACM. These findings may suggest that SGLT2is should be considered over GLP1RAs in terms of preventing CV and all-cause death and HHF in T2D patients.

show abstract

Section: Discussionmentioning

confidence: 99%

SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

Qiu

Xu-bin

Wei

2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…The availability of SGLT‐2is and GLP‐1RAs and data from large CV outcomes trials conducted with these agents has led to a shift in how diabetologists, cardiologists, nephrologists and primary care physicians view diabetes management. As a class, several, but not all, GLP‐1RAs significantly reduce the risk of atherosclerotic major adverse CV events in T2D patients 40,41 with established CV disease at enrolment 42 . SGLT‐2i use is associated with a reduction in the risk of CV mortality, hospitalization for heart failure and progression of renal disease 43,44 .…”

Section: The Changing Scenariomentioning

confidence: 99%

Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel

Consoli

Czupryniak

Duarte

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

The large number of pharmacological agents available to treat type 2 diabetes (T2D) makes choosing the optimal drug for any given patient a complex task. Because newer agents offer several advantages, whether and when sulphonylureas (SUs) should still be used to treat T2D is controversial. Published treatment guidelines and recommendations should govern the general approach to diabetes management. However, expert opinions can aid in better understanding local practices and in formulating individual choices. The current consensus paper aims to provide additional guidance on the use of SUs in T2D. We summarize current local treatment guidelines in European countries, showing that SUs are still widely proposed as second‐line treatment after metformin and are often ranked at the same level as newer glucose‐lowering medications. Strong evidence now shows that sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) are associated with low hypoglycaemia risk, promote weight loss, and exert a positive impact on vascular, cardiac and renal endpoints. Thus, using SUs in place of SGLT‐2is and GLP‐1RAs may deprive patients of key advantages and potentially important cardiorenal benefits. In subjects with ascertained cardiovascular disease or at very high cardiovascular risk, SGLT‐2is and/or GLP‐1RAs should be used as part of diabetes management, in the absence of contraindications. Routine utilization of SUs as second‐line agents continues to be acceptable in resource‐constrained settings.

show abstract

“…The harmful effect of developing heart failure appeared to be associated with improved glucose control and was explained, at least in part, by choice of treatment, as indicated in a recent meta-analysis [13]. Whether or not anti-diabetic medications directly contribute to the progression and/ or precipitation of heart failure, as well as which class of anti-diabetic medications is the optimal choice for this patient population, have henceforth been and are still being intensely debated and investigated [8,[14][15][16][17][18][19][20][21]. Previously, we have conducted a network metaanalysis to evaluate whether novel anti-diabetic agents, including dipeptidyl peptidase 4 (DDP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium-glucose co-transporter 2 (SGLT-2) inhibitors, were superior in terms of major adverse cardiovascular events (MACE) and all-cause mortality, compared with more traditional classes of drugs [22].…”

Section: Introductionmentioning

confidence: 99%

Comparative outcomes of heart failure among existent classes of anti-diabetic agents: a network meta-analysis of 171,253 participants from 91 randomized controlled trials

Yang

Liang³

et al. 2019

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background: The cardiovascular (CV) safety in terms of heart failure among different classes of treatment remains largely unknown. We sought to assess the comparative effect of these agents on heart failure outcomes. Methods:This study was registered in the International Prospective Register of Systematic Reviews (CRD 42016042063). MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched. For the primary outcomes reported previously, studies between Jan 1, 1980 and June 30, 2016 were screened, and subsequently updated till Jan 24, 2019. We performed network meta-analysis to obtain estimates for the outcomes of heart failure, in particular by rankograms for ranking of heart failure risk as well as by pairwise comparisons among all classes of anti-diabetic medications.Results: A total of 91 trials were included, among which were 171,253 participants and 4163 reported cases of heart failure events. As for rankograms, the surface under the cumulative ranking curves (SUCRA) of sodium-glucose co-transporters 2 and thiazolidinediones were 93.4% and 4.3%, respectively, signifying the lowest and highest risk of heart failure, respectively. As for pairwise comparisons in the network, sodium-glucose co-transporters 2 were significantly superior to insulin (OR: 0.75, 95% CI 0.62-0.91), dipeptidyl peptidase 4 inhibitors (OR: 0.68, 95% CI 0.59-0.78), glucagon-like peptide-1 receptor agonists (OR: 0.65, 95% CI 0.54-0.78), and thiazolidinediones (OR: 0.46, 95% CI 0.27-0.77) in terms of heart failure risk. Furthermore, in an exploratory analysis among subjects with underlying heart failure or at risk of heart failure, the superiority of sodium-glucose co-transporters 2 was still significant. Conclusions:In terms of heart failure risk, sodium-glucose co-transporters 2 were the most favorable option among all classes of anti-diabetic medications.

show abstract

Network meta-analysis of nine large cardiovascular outcome trials of new antidiabetic drugs

Cited by 16 publications

References 27 publications

SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

Positioning sulphonylureas in a modern treatment algorithm for patients with type 2 diabetes: Expert opinion from a European consensus panel

Comparative outcomes of heart failure among existent classes of anti-diabetic agents: a network meta-analysis of 171,253 participants from 91 randomized controlled trials

Contact Info

Product

Resources

About