非奈利酮与SGLT2抑制剂对2型糖尿病和/或慢性肾脏病患者心血管事件的影响

Effects of finerenone versus SGLT2 inhibitors on cardiovascular events in patients with type 2 diabetes mellitus and/or chronic kidney disease

目的比较非奈利酮与钠-葡萄糖共转运蛋白-2(sodium-glucose cotransporter-2,SGLT2)抑制剂对2型糖尿病和/或慢性肾脏病患者心血管事件的影响。方法检索PubMed、Cochrane Library、Web of Science和Embase数据库关于2型糖尿病和/或慢性肾脏病患者的随机对照试验,时间为建库至2023年7月3日。基于频率模型,使用STATA 17.0软件进行网状荟萃分析(network meta-analysis,NMA)。结果共纳入7项随机对照试验,包括33206例患者。涉及的治疗方式包括非奈利酮和SGLT2抑制剂,其中SGLT2抑制剂包含恩格列净、卡格列净、达格列净和索格列净(双重SGLT抑制剂)。在心血管复合事件方面,根据累计曲线下的概率面积(surface under the cumulative ranking area,SUCRA)排序,索格列净最有效。在心血管死亡方面,根据SUCRA排序,恩格列净最有效。在心力衰竭住院方面,根据SUCRA排序,卡格列净最有效。在全因死亡方面,根据SUCRA排序,达格列净最有效。非奈利酮和SGLT2抑制剂在不良事件、严重不良事件和急性肾损害的安全性方面比较,差异均无统计学意义(均P>0.05)。与采用非奈利酮治疗的患者相比,采用SGLT2抑制剂治疗的患者高钾血症发生率更低(RR=0.41,95%CI 0.32~0.52)。结论与非奈利酮相比,SGLT2抑制剂能更好地降低心血管事件的发生率,可作为2型糖尿病和/或慢性肾脏病患者的基础治疗,帮助预防或减少心血管事件。

Objective To compare the effects of finerenone versus sodium-glucose cotransporter protein-2(SGLT2)inhibitors on cardiovascular events in patients with type 2 diabetes mellitus and/or chronic kidney disease.Methods The PubMed,Cochrane Library,Web of Science,and Embase databases were searched for the randomized controlled trials on patients with type 2 diabetes mellitus and/or chronic kidney disease from their establishment to July 3,2023.This network meta-analysis(NMA)was performed using the STATA 17.0 software based on the frequency models.Results A total of 7 randomized controlled trials were included,including 33206 patients.The treatments included finerenone and SGLT2 inhibitors;the SGLT2 inhibitors included empagliflozin,canagliflozin,dapagliflozin,and sotagliflozin(a dual SGLT inhibitor).In terms of cardiovascular composite events,sotagliflozin was the most effective according to the surface under the cumulative ranking area(SUCRA)ranking.In terms of cardiovascular deaths,empagliflozin was the most effective according to the SUCRA ranking.In terms of hospitalization for heart failure,canagliflozin was the most effective according to the SUCRA ranking.In terms of all-cause mortality,dapagliflozin was the most effective according to the SUCRA ranking.There were no statistical differences between finerenone and SGLT2 inhibitors in terms of safety of adverse events,serious adverse events,and acute kidney damage.For patients with hyperkalemia,SGLT2 inhibitors had a lower incidence than finerenone(RR=0.41,95%CI 0.32~0.52).Conclusion SGLT2 inhibitors reduce the incidence of cardiovascular events better than finerenone and can be used as basic treatment for patients with type 2 diabetes mellitus and/or chronic kidney disease and help prevent or reduce cardiovascular events.