Impact of SGLT2 inhibitors on patient outcomes: a network meta-analysis

doi:10.1186/s12933-023-02035-8

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Title:	Impact of SGLT2 inhibitors on patient outcomes: a network meta-analysis
Authors:	Chen, Jui-Yi Pan, Heng-Chih Shiao, Chih-Chung Chuang, Min-Hsiang See, Chun Yin Yeh, Tzu-Hsuan Yang, Yafei Chu, Wen-Kai Wu, Vin-Cent
Contributors:	Chi Mei Med Ctr, Dept Internal Med, Div Nephrol Chia Nan Univ Pharm & Sci, Dept Hlth & Nutr Keelung Chang Gung Mem Hosp, Dept Internal Med, Div Nephrol Chang Gung Univ, Coll Med Natl Taiwan Univ, Grad Inst Clin Med, Coll Med Keelung Chang Gung Mem Hosp, Community Med Res Ctr Camillian St Marys Hosp Luodong, Dept Internal Med, Div Nephrol St Marys Jr Coll Med Nursing & Management Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med ,Div Nephrol Everan Hosp, Dept Internal Med, Div Nephrol Natl Taiwan Univ Hosp, Dept Internal Med Natl Taiwan Univ Hosp, NSARF, Study Grp ARF Taiwan Primary Aldosteronism Investigators
Keywords:	SGLT2 inhibitor Diabetes Heart failure Chronic kidney disease Network meta-analysis
Date:	2023
Issue Date:	2024-12-25 11:03:33 (UTC+8)
Publisher:	BMC
Abstract:	BackgroundA 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.MethodsWe 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).ResultsA 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).ConclusionsOur 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].ConclusionsOur 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].
Relation:	Cardiovascular Diabetology, v.22, n.1, Article 290
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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