Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease
Abstract Objective To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis....
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-022-01676-5 |
| _version_ | 1811328738735947776 |
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| author | Yaofu Zhang Li Jiang Junheng Wang Tongxin Wang Chieh Chien Weijun Huang Xiaozhe Fu Yonghua Xiao Qiang Fu Shidong Wang Jinxi Zhao |
| author_facet | Yaofu Zhang Li Jiang Junheng Wang Tongxin Wang Chieh Chien Weijun Huang Xiaozhe Fu Yonghua Xiao Qiang Fu Shidong Wang Jinxi Zhao |
| author_sort | Yaofu Zhang |
| collection | DOAJ |
| description | Abstract Objective To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis. Methods Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). Results 18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR [95% CI]; 0.88 [0.80–0.97], 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95% CI]; 0.84 [0.78–0.90]), renal outcome (RR [95% CI]; 0.67 [0.60–0.74], HHF (RR [95% CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95% CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95% CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95% CI]; 0.86 [0.78–0.94]). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95% CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95% CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively) in renal outcome and HHF. Conclusions In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues. |
| first_indexed | 2024-04-13T15:31:17Z |
| format | Article |
| id | doaj.art-b1a70e3ccc0c4d3d8b3afc6667f3cace |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-04-13T15:31:17Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-b1a70e3ccc0c4d3d8b3afc6667f3cace2022-12-22T02:41:23ZengBMCCardiovascular Diabetology1475-28402022-11-0121112310.1186/s12933-022-01676-5Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney diseaseYaofu Zhang0Li Jiang1Junheng Wang2Tongxin Wang3Chieh Chien4Weijun Huang5Xiaozhe Fu6Yonghua Xiao7Qiang Fu8Shidong Wang9Jinxi Zhao10Dongzhimen Hospital, Beijing University of Chinese MedicineDongzhimen Hospital, Beijing University of Chinese MedicineDongzhimen Hospital, Beijing University of Chinese MedicineNational Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical SciencesDepartment of Health Sciences and Medicine, University of LucerneKey Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital affiliated to Beijing University of Chinese MedicineDongzhimen Hospital, Beijing University of Chinese MedicineSection II of Endocrinology & Nephropathy Department of Dongzhimen Hospital affiliated to Beijing University of Chinese MedicineSection II of Endocrinology & Nephropathy Department of Dongzhimen Hospital affiliated to Beijing University of Chinese MedicineDongzhimen Hospital, Beijing University of Chinese MedicineDongzhimen Hospital, Beijing University of Chinese MedicineAbstract Objective To evaluate the cardiovascular and renal benefits of finerenone, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagonlike peptide-1 receptor agonists (GLP-1 RA) in patients with Type 2 Diabetes Mellitus (T2DM) and chronic kidney disease (CKD) with network meta-analysis. Methods Systematic literature searches were conducted of PubMed, Cochrane Library, Web of Science, Medline and Embase covering January 1, 2000 to December 30, 2021. Randomized control trials (RCTs) comparing finerenone, SGLT-2i and GLP-1 RA in diabetics with CKD were selected. We performed a network meta-analysis to compare the two drugs and finerenone indirectly. Results were reported as risk ratio (RR) with corresponding 95% confidence interval (CI). Results 18 RCTs involving 51,496 patients were included. Finerenone reduced the risk of major adverse cardiovascular events (MACE), renal outcome and hospitalization for heart failure (HHF) (RR [95% CI]; 0.88 [0.80–0.97], 0.86 [0.79–0.93], 0.79 [0.67,0.92], respectively). SGLT-2i were associated with reduced risks of MACE (RR [95% CI]; 0.84 [0.78–0.90]), renal outcome (RR [95% CI]; 0.67 [0.60–0.74], HHF (RR [95% CI]; 0.60 [0.53–0.68]), all-cause death (ACD) (RR [95% CI]; 0.89 [0.81–0.91]) and cardiovascular death (CVD) (RR [95% CI]; 0.86 [0.77–0.96]) compared to placebo. GLP-1 RA were associated with a lower risk of MACE (RR [95% CI]; 0.86 [0.78–0.94]). SGLT2i had significant effect in comparison to finerenone (finerenone vs SGLT2i: RR [95% CI]; 1.29 [1.13–1.47], 1.31 [1.07–1.61], respectively) and GLP-1 RA (GLP-1 RA vs SGLT2i: RR [95% CI]; 1.36 [1.16–1.59], 1.49 [1.18–1.89], respectively) in renal outcome and HHF. Conclusions In patients with T2DM and CKD, SGLT2i, GLP-1 RA and finerenone were comparable in MACE, ACD and CVD. SGLT2i significantly decreased the risk of renal events and HHF compared with finerenone and GLP-1 RA. Among GLP-1 RA, GLP-1 analogues showed significant effect in reducing cardiovascular events compared with exendin-4 analogues.https://doi.org/10.1186/s12933-022-01676-5FinerenoneSGLT2 inhibitorsGLP-1 receptor agonistNetwork meta-analysisCardiovascular outcomeRenal outcome |
| spellingShingle | Yaofu Zhang Li Jiang Junheng Wang Tongxin Wang Chieh Chien Weijun Huang Xiaozhe Fu Yonghua Xiao Qiang Fu Shidong Wang Jinxi Zhao Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease Cardiovascular Diabetology Finerenone SGLT2 inhibitors GLP-1 receptor agonist Network meta-analysis Cardiovascular outcome Renal outcome |
| title | Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease |
| title_full | Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease |
| title_fullStr | Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease |
| title_full_unstemmed | Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease |
| title_short | Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease |
| title_sort | network meta analysis on the effects of finerenone versus sglt2 inhibitors and glp 1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease |
| topic | Finerenone SGLT2 inhibitors GLP-1 receptor agonist Network meta-analysis Cardiovascular outcome Renal outcome |
| url | https://doi.org/10.1186/s12933-022-01676-5 |
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