Efficacy and safety of SGLT2 inhibitors with and without glucagon-like peptide 1 receptor agonists: a SMART-C collaborative meta-analysis of randomised controlled trials
Résumé
Treatment effects from individual trials were obtained from Cox regression models and pooled using inverse variance weighted meta-analysis. Outcomes assessed included major adverse cardiovascular events ([MACE] myocardial infarction, stroke or cardiovascular death), hospitalisation for heart failure (HF) or cardiovascular death, CKD progression (≥40% decline in estimated glomerular filtration rate [eGFR], kidney failure or death due to kidney failure), as well as safety outcomes. Results Across 12 randomised, double-blind, placebo-controlled trials, 3,065/72,970 (4.0%) participants with diabetes were using GLP-1RA at baseline. SGLT2i reduced the risk of MACE in participants receiving and not receiving GLP-1RA (hazard ratio [HR] 0.81, 95% CI 0.63-1.03 and HR 0.90, 95% CI 0.86-0.94, respectively; P-heterogeneity=0.31). Effects on hospitalisation for HF or cardiovascular death (HR 0.76, 95% CI 0.57-1.01 and HR 0.78, 95% CI 0.74-0.82, respectively; P-heterogeneity=0.90) and CKD progression (HR 0.65, 95% CI 0.46-0.94 and HR 0.67, 95% CI 0.62-0.72, respectively; P-heterogeneity=0.81) were also consistent regardless of GLP-1RA use. Fewer serious adverse events occurred with SGLT2i