Comparative Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-Like Peptide 1 Receptor Agonists, and Nonsteroidal Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease and Type 2 Diabetes: A Systematic Review and Network Meta-Analysis

Link to article at PubMed

Diabetes Obes Metab. 2023 Feb 8. doi: 10.1111/dom.15009. Online ahead of print.


AIMS: This network meta-analysis compares relative efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT-2i), glucagon-like peptide 1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRA) in improving cardiovascular and renal outcomes in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We searched PubMed, Embase, and Cochrane Library from inception through November 25, 2022. We selected randomized controlled trials that studied patients with CKD and T2D with follow-up of at least 24 weeks and compared SGLT-2i, GLP-1RA, and nsMRA with each other and with placebo. Primary outcomes were major adverse cardiovascular events (MACE) and composite renal outcomes (CRO). Secondary outcomes were cardiovascular death, all-cause death, stroke, myocardial infarction, and heart failure hospitalization (HFH). A frequentist approach was used to pool risk ratios (RR) with 95% confidence intervals (CI).

RESULTS: 29 studies with 50,938 participants for MACE and 49,965 participants for CRO were included. SGLT-2i did not significantly reduce MACE but were associated with significantly lower risks of CRO compared with GLP-1RA (RR, 0.77; 95% CI, 0.64-0.91; p = 0.003) and nsMRA (RR, 0.78; 95% CI, 0.68-0.90; p = 0.001). Compared with GLP-1RA and nsMRA, SGLT-2i significantly reduced HFH (RR, 0.69; 95% CI, 0.55-0.88; p = 0.002) and (RR, 0.78; 95% CI, 0.63-0.95; p = 0.016), respectively, but did not significantly reduce other secondary outcomes. There were no significant differences between GLP-1RA and nsMRA in lowering all outcomes.

CONCLUSION: SGLT-2i were associated with better cardiorenal protection than GLP-1RA and nsMRA in patients with CKD and T2D. This article is protected by copyright. All rights reserved.

PMID:36751968 | DOI:10.1111/dom.15009

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