AI Article Synopsis
- - A comprehensive network meta-analysis was performed on SGLT2 inhibitors, analyzing data from 14 trials with over 75,000 patients, aiming to compare their effectiveness in populations with and without conditions like diabetes, heart failure, and chronic kidney disease.
- - Key findings showed that empagliflozin users had a significantly lower all-cause mortality risk compared to dapagliflozin users in the diabetic population, while canagliflozin users had a reduced risk of cardiovascular death or hospitalization in non-heart failure patients compared to dapagliflozin users.
- - The analysis also indicated that less selective SGLT2 inhibitors led to significantly lower risks of major adverse cardiovascular events in heart failure patients compared to highly
Article Abstract
Background: A comprehensive network meta-analysis comparing the effects of individual sodium-glucose cotransporter 2 (SGLT2) inhibitors on patients with and without comorbidities including diabetes mellitus (DM), heart failure (HF), and chronic kidney disease (CKD) has not been previously conducted.
Methods: We searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials up to March 28, 2023. Network meta-analysis using a random-effects model was conducted to calculate risk ratios (RRs). Risk of Bias tool 2.0 was used to assess bias, and CINeMA to assess the certainty of evidence. In the subgroup analysis, the SGLT2 inhibitors were classified into highly (dapagliflozin, empagliflozin, and ertugliflozin) and less selective SGLT2 inhibitors (canagliflozin and sotagliflozin).
Results: A total of fourteen trials with 75,334 patients were analyzed. Among these, 40,956 had taken SGLT2 inhibitors and 34,378 had not. One of the main results with particular findings was empagliflozin users had a significantly lower risk of all-cause death compared to dapagliflozin users in DM population (RR: 0.81, 95% CI 0.69-0.96). In HF population, sotagliflozin users had a borderline significantly lower risk of CV death or hospitalization for HF (HHF) than dapagliflozin users (RR: 0.90, 95% CI 0.80-1.01). In non-HF population, those who used canagliflozin had a significantly lower risk of CV death or HHF compared with those who used dapagliflozin (RR: 0.75, 95% CI 0.58-0.98). At last, for HF patients, those who used less selective SGLT2 inhibitors had a significantly lower risk of MACEs compared to those who used highly selective SGLT2 inhibitors (RR: 0.75, 95% CI 0.62-0.90).
Conclusions: Our network meta-analysis revealed that empagliflozin users with diabetes experienced a lower risk of dying from any cause than those using dapagliflozin. Additionally, canagliflozin users demonstrated a reduced risk of cardiovascular death or HHF compared to dapagliflozin users in those without HF. In HF patients, less selective SGLT2 inhibitors showed superior CV composite outcomes, even surpassing the performance of highly selective SGLT2 inhibitors.
Trial Registration: PROSPERO [CRD42022361906].
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612254 | PMC |
| http://dx.doi.org/10.1186/s12933-023-02035-8 | DOI Listing |
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