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Conference Paper: Network meta-analysis of cardiovascular outcomes in randomised controlled trials of new antidiabetic drugs

TitleNetwork meta-analysis of cardiovascular outcomes in randomised controlled trials of new antidiabetic drugs
Authors
Issue Date2017
PublisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/clinthera
Citation
The 13th Congress of the European Association for Clinical Pharmacology and Therapeutics (EACPT), Prague, Czech Republic, 24-27 June 2017. In Clinical Therapeutics, 2017, v. 39 n. 8S, p. e49-e50 How to Cite?
AbstractBackground: The prevalence of cardiovascular disease is high in patients with type 2 diabetes mellitus (T2DM). However, evidence from randomised controlled trials (RCTs) that directly compared the effect of new antidiabetic drugs on cardiovascular outcomes in these patients was limited. We performed a network meta-analysis to assess the cardiovascular safety of different classes of these drugs. Methods: We searched for RCTs involving glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose co-transporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors in T2DM patients with established cardiovascular risks. RCTs that reported rates of major adverse cardiovascular events and mortality were eligible to be included. Both frequentist approach and Bayesian framework were used for analysis in R. Results: We included 7 RCTs with altogether 62268 T2DM patients in our network meta-analysis. GLP-1 RAs and the SGLT-2 inhibitor reduced MACE (OR 0.89, 0.82-0.97 and 0.85, 95%CI 0.73-0.99, respectively) and all-cause mortality (0.89, 0.80-0.99 and 0.67, 0.55-0.81, respectively) when compared to placebo. The SGLT-2 inhibitor reduced all-cause mortality more than GLP-1 RAs (OR 0.76, 95%CI 0.61-0.94). Moreover, DPP-4 inhibitors were comparable to placebo but associated with increased allcause mortality when compared to the SGLT-2 inhibitor (1.53, 1.24-1.89) and GLP-1 RAs (1.16, 1.01-1.33), respectively. Conclusions: The SGLT-2 inhibitor and GLP-1 RAs reduced all-cause mortality and MACE, which were both superior to DPP-4 inhibitors. The SGLT-2 inhibitor was more beneficial in preventing deaths than the other two drugs classes, which can be used as the prior secondline treatment for T2DM patients to reduce cardiovascular risks.
Persistent Identifierhttp://hdl.handle.net/10722/247885
ISSN
2017 Impact Factor: 3.185
2015 SCImago Journal Rankings: 0.997

 

DC FieldValueLanguage
dc.contributor.authorFei, Y-
dc.contributor.authorTsoi, MF-
dc.contributor.authorKumana, CR-
dc.contributor.authorCheung, TT-
dc.contributor.authorCheung, BMY-
dc.date.accessioned2017-10-18T08:34:14Z-
dc.date.available2017-10-18T08:34:14Z-
dc.date.issued2017-
dc.identifier.citationThe 13th Congress of the European Association for Clinical Pharmacology and Therapeutics (EACPT), Prague, Czech Republic, 24-27 June 2017. In Clinical Therapeutics, 2017, v. 39 n. 8S, p. e49-e50-
dc.identifier.issn0149-2918-
dc.identifier.urihttp://hdl.handle.net/10722/247885-
dc.description.abstractBackground: The prevalence of cardiovascular disease is high in patients with type 2 diabetes mellitus (T2DM). However, evidence from randomised controlled trials (RCTs) that directly compared the effect of new antidiabetic drugs on cardiovascular outcomes in these patients was limited. We performed a network meta-analysis to assess the cardiovascular safety of different classes of these drugs. Methods: We searched for RCTs involving glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose co-transporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase-4 (DPP-4) inhibitors in T2DM patients with established cardiovascular risks. RCTs that reported rates of major adverse cardiovascular events and mortality were eligible to be included. Both frequentist approach and Bayesian framework were used for analysis in R. Results: We included 7 RCTs with altogether 62268 T2DM patients in our network meta-analysis. GLP-1 RAs and the SGLT-2 inhibitor reduced MACE (OR 0.89, 0.82-0.97 and 0.85, 95%CI 0.73-0.99, respectively) and all-cause mortality (0.89, 0.80-0.99 and 0.67, 0.55-0.81, respectively) when compared to placebo. The SGLT-2 inhibitor reduced all-cause mortality more than GLP-1 RAs (OR 0.76, 95%CI 0.61-0.94). Moreover, DPP-4 inhibitors were comparable to placebo but associated with increased allcause mortality when compared to the SGLT-2 inhibitor (1.53, 1.24-1.89) and GLP-1 RAs (1.16, 1.01-1.33), respectively. Conclusions: The SGLT-2 inhibitor and GLP-1 RAs reduced all-cause mortality and MACE, which were both superior to DPP-4 inhibitors. The SGLT-2 inhibitor was more beneficial in preventing deaths than the other two drugs classes, which can be used as the prior secondline treatment for T2DM patients to reduce cardiovascular risks.-
dc.languageeng-
dc.publisherExcerpta Medica, Inc. The Journal's web site is located at http://www.elsevier.com/locate/clinthera-
dc.relation.ispartofClinical Therapeutics-
dc.rightsPosting accepted manuscript (postprint): © <year>. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/-
dc.titleNetwork meta-analysis of cardiovascular outcomes in randomised controlled trials of new antidiabetic drugs-
dc.typeConference_Paper-
dc.identifier.emailKumana, CR: hrmekcr@hku.hk-
dc.identifier.emailCheung, TT: tcheungt@hku.hk-
dc.identifier.emailCheung, BMY: mycheung@hkucc.hku.hk-
dc.identifier.authorityCheung, TT=rp01682-
dc.identifier.authorityCheung, BMY=rp01321-
dc.identifier.doi10.1016/j.clinthera.2017.05.153-
dc.identifier.hkuros282105-
dc.identifier.volume39-
dc.identifier.issue8S-
dc.identifier.spagee49-
dc.identifier.epagee50-
dc.publisher.placeUnited States-

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