司美格鲁肽在首次或既往使用胰高血糖素样肽-1受体激动剂的2型糖尿病患者中有效性的系统评价

Systematic review of the efficacy of semaglutide in patients with T2DM who were first-time or previously used glucagon-like peptide-1 receptor agonists

目的系统评价司美格鲁肽在首次或既往使用胰高血糖素样肽-1受体激动剂(GLP-1RA)的2型糖尿病(T2DM)患者中的有效性,以期为临床提供参考。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、ClinicalTrials.gov、中国期刊全文数据库、万方数据知识服务平台、维普资讯等数据库,纳入司美格鲁肽治疗T2DM的真实世界研究。根据ROBINS-I工具对纳入研究的质量进行评价。采用Stata15.0和RevMan 5.4软件进行meta分析。结果共纳入11项研究,涉及13384例T2DM患者。初次和既往使用GLP-1RA患者的糖化血红蛋白(HbA1c)相对基线改变分别为-1.18%(95%CI:-1.33~-1.04,P<0.01)和-0.65%(95%CI:-0.72~-0.58,P<0.001);初次和既往使用GLP-1RA患者的体质量相比基线变化分别为-5.02 kg(95%CI:-5.80~-4.24,P<0.001)和-2.69 kg(95%CI:-3.29~-2.09,P<0.001);初次使用GLP-1RA患者的HbA1c和体质量改善程度明显优于既往使用GLP-1RA的患者[(MD=-0.52,95%CI:-0.64~-0.40,P<0.001)和(MD=-1.75,95%CI:-2.52~-0.97,P<0.001)]。不良反应主要以低血糖和胃肠道反应为主。结论司美格鲁肽可以有效降低患者HbA1c和体质量,且对于初次使用GLP-1RA类药物的患者效果更佳。

Objective To systematically evaluate the efficacy of semaglutide in GLP-1RA-experienced type 2 diabetic patients and GLP-1RA Na?ve,so as to provide reference for clinical practice.Methods Databases including PubMed,Embase,Cochrane Library,Web of Science and ClinicalTrials Gov,CNKI,Wanfang and Vip databases were searched for real-world studies about semaglutide in the treatment of type 2 diabetes mellitus(T2DM).ROBINS-I tool was used to evaluate the quality of the included studies.Meta-analysis was conducted by Stata 15.0 and RevMan 5.4 software.Results A total of 11 real-world studies were included,involving 13384 patients with T2DM.The changes in HbA1c compared to baseline were-1.18%(95%CI:-1.33 to-1.04,P<0.001)and-0.65%(95%CI:-0.72 to-0.58,P<0.001)in patients who were GLP-1RA na?ve and switching from another GLP-1RA,respectively.The changes in body weight compared to baseline were-5.02 kg(95%CI:-5.80 to-4.24,P<0.001)and-2.69 kg(95%CI:-3.29 to-2.09,P<0.001)for patients who were GLP-1RA na?ve and switching from another GLP-1RA,respectively.The improvement of HbA1c and weight in GLP-1RA na?ve were significantly higher than those of patients who were switching from another GLP-1RA,with(MD=-0.52,95%CI:-0.64 to-0.40,P<0.001)and(MD=-1.75,95%CI:-2.52 to-0.97,P<0.001),respectively.The reported adverse events were mainly hypoglycemia and gastrointestinal events.Conclusion Semaglutide can effectively improve HbA1c and body weight,and is more effective for patients who were GLP-1RA na?ve.