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Conference Paper: Cardiovascular outcomes in trials of new antidiabetic drug classes: a network meta-analysis

TitleCardiovascular outcomes in trials of new antidiabetic drug classes: a network meta-analysis
Authors
Issue Date2019
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/
Citation
24th Medical Research Conference, Department of Medicine, The University of Hong Kong, Hong Kong, 19 January 2019. In Hong Kong Medical Journal, 2019, v. 25 n. 1, Suppl. 1, p. 17 How to Cite?
AbstractIntroduction: New antidiabetic drugs are required to demonstrate safety in cardiovascular outcome trials. However, they are rarely compared with each other. We therefore performed a network meta-analysis to compare new antidiabetic drug classes with respect to cardiovascular outcomes. Methods: We searched for cardiovascular outcome trials 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 patients with type 2 diabetes mellitus (T2DM) using major adverse cardiovascular events (MACEs) and mortality as endpoints. Network meta-analysis was performed using random-effects model in R. Results: Ten trials with altogether 81 825 patients with T2DM were eligible to be included. Glucagon-like peptide-1 receptor agonists and SGLT-2 inhibitors significantly reduced MACEs (odds ratio [OR]=0.86, 95% confidence interval [CI]=0.78-0.94 and OR=0.86, 95% CI=0.76-0.96) when compared with placebo. Sodiumglucose co-transporter 2 inhibitors significantly reduced cardiovascular mortality and all-cause mortality when compared with DPP-4 inhibitors (OR=0.77, 95% CI=0.61-0.98 and OR=0.77, 95% CI=0.64-0.92) and placebo (OR=0.76, 0.63-0.92 and OR=0.79, 95% CI=0.68-0.91), respectively. Glucagon-like peptide-1 receptor agonists lowered the risk of MACEs (OR=0.87, 95% CI=0.77-0.99) compared with DPP-4 inhibitors, and showed a trend towards a lower risk of non-fatal myocardial infarction (OR=0.87, 95% CI=0.76-1.00) when compared with placebo. No significant differences were found in the risk of non-fatal stroke. Conclusion: Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors both reduce MACEs when compared with placebo. Sodium-glucose co-transporter 2 inhibitors are the most beneficial in reduce mortality while GLP-1 RAs reduce cardiovascular events the most. Dipeptidyl peptidase-4 inhibitors do not worsen cardiovascular outcomes, but are inferior to GLP-1 RAs and SGLT-2 inhibitors. Our findings support SGLT-2 inhibitors and GLP-1 RAs as the preferred treatment for patients with T2DM to reduce cardiovascular risk.
Persistent Identifierhttp://hdl.handle.net/10722/268245
ISSN
2017 Impact Factor: 1.226
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorFei, Y-
dc.contributor.authorTsoi, MF-
dc.contributor.authorCheung, BMY-
dc.date.accessioned2019-03-18T04:21:37Z-
dc.date.available2019-03-18T04:21:37Z-
dc.date.issued2019-
dc.identifier.citation24th Medical Research Conference, Department of Medicine, The University of Hong Kong, Hong Kong, 19 January 2019. In Hong Kong Medical Journal, 2019, v. 25 n. 1, Suppl. 1, p. 17-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/268245-
dc.description.abstractIntroduction: New antidiabetic drugs are required to demonstrate safety in cardiovascular outcome trials. However, they are rarely compared with each other. We therefore performed a network meta-analysis to compare new antidiabetic drug classes with respect to cardiovascular outcomes. Methods: We searched for cardiovascular outcome trials 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 patients with type 2 diabetes mellitus (T2DM) using major adverse cardiovascular events (MACEs) and mortality as endpoints. Network meta-analysis was performed using random-effects model in R. Results: Ten trials with altogether 81 825 patients with T2DM were eligible to be included. Glucagon-like peptide-1 receptor agonists and SGLT-2 inhibitors significantly reduced MACEs (odds ratio [OR]=0.86, 95% confidence interval [CI]=0.78-0.94 and OR=0.86, 95% CI=0.76-0.96) when compared with placebo. Sodiumglucose co-transporter 2 inhibitors significantly reduced cardiovascular mortality and all-cause mortality when compared with DPP-4 inhibitors (OR=0.77, 95% CI=0.61-0.98 and OR=0.77, 95% CI=0.64-0.92) and placebo (OR=0.76, 0.63-0.92 and OR=0.79, 95% CI=0.68-0.91), respectively. Glucagon-like peptide-1 receptor agonists lowered the risk of MACEs (OR=0.87, 95% CI=0.77-0.99) compared with DPP-4 inhibitors, and showed a trend towards a lower risk of non-fatal myocardial infarction (OR=0.87, 95% CI=0.76-1.00) when compared with placebo. No significant differences were found in the risk of non-fatal stroke. Conclusion: Glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors both reduce MACEs when compared with placebo. Sodium-glucose co-transporter 2 inhibitors are the most beneficial in reduce mortality while GLP-1 RAs reduce cardiovascular events the most. Dipeptidyl peptidase-4 inhibitors do not worsen cardiovascular outcomes, but are inferior to GLP-1 RAs and SGLT-2 inhibitors. Our findings support SGLT-2 inhibitors and GLP-1 RAs as the preferred treatment for patients with T2DM to reduce cardiovascular risk.-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/-
dc.relation.ispartofHong Kong Medical Journal-
dc.relation.ispartof24th Annual Medical Research Conference, Department of Medicine, The University of Hong Kong-
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press.-
dc.titleCardiovascular outcomes in trials of new antidiabetic drug classes: a network meta-analysis-
dc.typeConference_Paper-
dc.identifier.emailCheung, BMY: mycheung@hkucc.hku.hk-
dc.identifier.authorityCheung, BMY=rp01321-
dc.identifier.hkuros297244-
dc.identifier.volume25-
dc.identifier.issue1, Suppl. 1-
dc.identifier.spage17-
dc.identifier.epage17-
dc.publisher.placeHong Kong-

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