Osamah M Alfayez1, Majed S Al Yami2, Mohannad Alshibani3, Saad B Fallatah4, Nasser M Al Khushaym5, Razan Alsheikh3, Nimer Alkhatib6. 1. Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Qassim University, Qassim, Saudi Arabia. Electronic address: ossalfayez@gmail.com. 2. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 3. Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; King Abdulaziz University, Jeddah, Saudi Arabia. 4. Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Taibah University, Madinah, Saudi Arabia. 5. Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Royal Commission Health Services Program, Jubail, Saudi Arabia. 6. Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA.
Abstract
The aim of this network meta-analysis (NMA) was to indirectly compare the cardiovascular (CV) safety of new antidiabetic medications in patients with type 2 diabetes mellitus (T2DM). DATA SYNTHESIS: A search of the Embase and MEDLINE databases was conducted systematically to identify cardiovascular outcome trials (CVOTs) of new antidiabetic medications (DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors) in patients with T2DM. The primary outcomes were the composite endpoint of CV death, nonfatal MI, and nonfatal stroke (MACE), death from CV causes, nonfatal MI, nonfatal stroke and death from any cause. Hospitalization for HF and unstable angina were evaluated as secondary endpoints. A total of 9 trials, including 87,162 patients, met the eligibility criteria and were retained for the analysis. The NMA results showed no significant differences among the DPP-4 inhibitors (sitagliptin, alogliptin, and saxagliptin) in any of the CV endpoints. Similarly, no significant changes were seen in the NMA among the GLP-1 receptor agonists nor the SGLT-2 inhibitors. The pairwise meta-analysis showed that DPP-4 inhibitors have a CV safety profiled comparable to placebo. GLP-1 agonists on the other hand, showed significant reduction in MACE (RR 0.92; 95% CI 0.87-0.97), death from CV causes (RR=0.88; 95% CI 0.80-0.97), and death from any cause (RR=0.89; 95% CI 0.82-0.96). SGLT-2 inhibitors showed significant reduction in hospitalization for heart failure events (RR 0.72; 95% CI 0.6-0.86) compared to placebo. CONCLUSION: This meta-analysis has shown that new antidiabetic medications do not impose any additional CV risk. The indirect comparison among the medications of each class resulted in no significant changes regarding CV endpoints and death from any cause.
The aim of this network meta-analysis (NMA) was to indirectly compare the cardiovascular (CV) safety of new antidiabetic medications in patients with type 2 diabetes mellitus (T2DM). DATA SYNTHESIS: A search of the Embase and MEDLINE databases was conducted systematically to identify cardiovascular outcome trials (CVOTs) of new antidiabetic medications (DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors) in patients with T2DM. The primary outcomes were the composite endpoint of CV death, nonfatal MI, and nonfatal stroke (MACE), death from CV causes, nonfatal MI, nonfatal stroke and death from any cause. Hospitalization for HF and unstable angina were evaluated as secondary endpoints. A total of 9 trials, including 87,162 patients, met the eligibility criteria and were retained for the analysis. The NMA results showed no significant differences among the DPP-4 inhibitors (sitagliptin, alogliptin, and saxagliptin) in any of the CV endpoints. Similarly, no significant changes were seen in the NMA among the GLP-1 receptor agonists nor the SGLT-2 inhibitors. The pairwise meta-analysis showed that DPP-4 inhibitors have a CV safety profiled comparable to placebo. GLP-1 agonists on the other hand, showed significant reduction in MACE (RR 0.92; 95% CI 0.87-0.97), death from CV causes (RR=0.88; 95% CI 0.80-0.97), and death from any cause (RR=0.89; 95% CI 0.82-0.96). SGLT-2 inhibitors showed significant reduction in hospitalization for heart failure events (RR 0.72; 95% CI 0.6-0.86) compared to placebo. CONCLUSION: This meta-analysis has shown that new antidiabetic medications do not impose any additional CV risk. The indirect comparison among the medications of each class resulted in no significant changes regarding CV endpoints and death from any cause.
Authors: Jason T Alexander; Erin M Staab; Wen Wan; Melissa Franco; Alexandra Knitter; M Reza Skandari; Shari Bolen; Nisa M Maruthur; Elbert S Huang; Louis H Philipson; Aaron N Winn; Celeste C Thomas; Meltem Zeytinoglu; Valerie G Press; Elizabeth L Tung; Kathryn Gunter; Brittany Bindon; Sanjay Jumani; Neda Laiteerapong Journal: J Gen Intern Med Date: 2021-11-30 Impact factor: 6.473
Authors: Trevor Yeong; Aaron Shengting Mai; Oliver Z H Lim; Cheng Han Ng; Yip Han Chin; Phoebe Tay; Chaoxing Lin; Mark Muthiah; Chin Meng Khoo; Mayank Dalakoti; Poay-Huan Loh; Mark Chan; Tiong-Cheng Yeo; Roger Foo; Raymond Wong; Nicholas W S Chew; Weiqin Lin Journal: ESC Heart Fail Date: 2022-01-29