不同剂量替西帕肽治疗2型糖尿病有效性和安全性的网状Meta分析

Efficacy and safety of tirzepatide at different doses in the treatment of type 2 diabetes mellitus:a network meta-analysis

目的采用网状Meta分析评价不同剂量替西帕肽治疗2型糖尿病(Type 2 diabetes mellitus,T2DM)的有效性和安全性。方法检索PubMed、Embase、Cochrane Library、中国知网和万方数据库,收集不同剂量替西帕肽治疗T2DM的随机对照试验(Randomized controlled trials,RCTs),检索时限均从建库至2023年6月。由2名研究者独立筛选文献,提取文献并评价纳入文献的偏倚风险后,采用STATA17.0软件进行网状Meta分析。结果本研究共纳入10篇RCT,涉及6种干预措施,包括替西帕肽15 mg、替西帕肽10 mg、替西帕肽5 mg、胰岛素、胰高血糖素样肽-1受体激动剂(GLP-1RA)和安慰剂,涉及8524例糖尿病患者。网状Meta分析结果显示,药物有效性主要指标糖化血红蛋白(HbA1c)降低程度累积排序概率图曲线下面积(SUCRA)排序依次为替西帕肽15 mg>替西帕肽10 mg>替西帕肽5 mg>GLP-1RA>胰岛素。药物安全性方面,胰岛素、安慰剂、替西帕肽5 mg更有优势。结论大剂量下的替西帕肽可以更有效地降低T2DM患者的HbA1c、空腹血糖(FPG)、体重,但需要警惕其不良反应。

Objective To evaluate the efficacy and safety of tirzepatide in the treatment of type 2 diabetes mellitus(T2DM)by network Meta-analysis.Methods PubMed,EMBASE,Cochrane Library,CNKI and Wanfang databases were searched to collect randomized controlled trials(RCTs)on the treatment of T2DM with different doses of tirzepatide.The retrieval time was from establishment of the database to June 2023.Two researchers independently screened the literatures,extracted the literatures and evaluated the migration risks of the included literatures.Then STATA 17.0 was used to perform the network Meta-analysis.Results A total of 10 RCTS involving 6 interventions(tirzepatide 15 mg,tirzepatide 10 mg,tirzepatide 5 mg,insulin,GLP-1RA and placebo)were included in this study,including 8524 diabetic patients.The results of network Meta-analysis showed that the main index of drug effectiveness was the degree of glycated hemoglobin reduction,and the probability of SUCRA ranked in order of tirzepatide 15 mg>tirzepatide 10 mg>tirzepatide 5 mg>GLP-1RA>insulin.In terms of drug safety,insulin,placebo and tirzepatide 5 mg had more advantages.Conclusion High-dose tirzepatide can effectively reduce HbA1c,FPG and body weight in T2DM patients,but its adverse reactions should be paid attention to.