■ 試験デザイン
T 6つのRCTをメタ分析:DPP4阻害薬3つ GLP1作動薬3つ
P 2型糖尿病患者and心血管リスクが高い患者
E GLP1作動薬、DPP4阻害薬
C プラセボ
O CV outcomes、膵臓事象、低血糖症

*CV outcomes=MACE(all-cause mortality, CV mortality, major adverse CV events), nonfatal myocardial infarction (MI), nonfatal stroke and heart failure hospitalization. In addition, the incidences of pancreatic outcomes (acute pancreatitis and pancreatic cancer) and hypoglycemia (any hypoglycemia and severe hypoglycemia)

■ 結果

When we evaluated the combined effect of six trials, the results suggested that incretin-based treatment had no significant effect on overall risks of CV and pancreatic outcomes compared with placebo. However, GLP-1As reduced all-cause death (RR = 0.90, 95% CI 0.82-0.98) and CV mortality (RR = 0.84, 95% CI 0.73-0.97)

■ 副作用

whereas DPP-4Is had no significant effect on CV outcomes but elevated the risk for acute pancreatitis (OR = 1.76, 95% CI 1.14-2.72) and hypoglycemia (both any and severe hypoglycemia), while GLP-1As lowered the risk of severe hypoglycemia.


■ 参照文献
Zhang Z et al., Cardiovasc Diabetol. 2017 Mar 1;16(1):31. PMID: 28249585