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Cardiovascular efficacy and safety of sodium‐glucose co‐transporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists: a systematic review and network meta‐analysis
Author(s) -
Hussein H.,
Zaccardi F.,
Khunti K.,
Seidu S.,
Davies M. J.,
Gray L. J.
Publication year - 2019
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.13898
Subject(s) - medicine , hazard ratio , myocardial infarction , type 2 diabetes , stroke (engine) , placebo , diabetes mellitus , heart failure , adverse effect , confidence interval , meta analysis , pharmacology , cardiology , endocrinology , mechanical engineering , alternative medicine , pathology , engineering
Aims To compare the cardiovascular efficacy and safety of sodium‐glucose co‐transporter‐2 ( SGLT 2) inhibitors and glucagon‐like peptide‐1 receptor agonists ( GLP ‐1 RA s) in adults with Type 2 diabetes. Methods Electronic databases were searched from inception to 22 October 2018 for randomized controlled trials designed to assess the cardiovascular efficacy of SGLT 2 inhibitors or GLP ‐1 RA s with regard to a three‐point composite measure of major adverse cardiovascular events (non‐fatal stroke, non‐fatal myocardial infarction and cardiovascular mortality). Cardiovascular and safety data were synthesized using Bayesian network meta‐analyses. Results Eight trials, including 60 082 participants, were deemed eligible for the network meta‐analysis. Both SGLT 2 inhibitors [hazard ratio 0.86 (95% credible interval 0.74, 1.01]) and GLP ‐1 RA s [hazard ratio 0.88 (95% credible interval 0.78, 0.98)] reduced the three‐point composite measure compared to placebo, with no evidence of differences between them [ GLP ‐1 RA s vs SGLT 2 inhibitors: hazard ratio 1.02 (95% credible interval 0.83, 1.23)]. SGLT 2 inhibitors reduced risk of hospital admission for heart failure compared to placebo [hazard ratio 0.67 (95% credible interval 0.53, 0.85)] and GLP ‐1 RA s [hazard ratio 0.71 (95% credible interval 0.53, 0.93)]. No differences were found between the two drug classes in non‐fatal stroke, non‐fatal myocardial infarction, cardiovascular mortality, all‐cause mortality or safety outcomes. Conclusions SGLT 2 inhibitors and GLP ‐1 RA s reduced the three‐point major adverse cardiovascular event risk compared to placebo, with no differences between them. Compared with GLP ‐1 RA s and placebo, SGLT 2 inhibitors led to a larger reduction in hospital admission for heart failure risk.