Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis
Objectives Assess the efficacy and safety profiles of different sodium-glucose cotransporter-2 inhibitors (SGLT2is) as an add-on to metformin in type 2 diabetes mellitus (T2DM) patients.Design Bayesian network meta-analysis.Data sources PubMed, Embase, Cochrane Library, Web of Science and ClinicalTr...
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BMJ Publishing Group
2025-02-01
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| Online Access: | https://bmjopen.bmj.com/content/15/2/e088687.full |
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| author | Yue Li Zihan Wang Haiyang Liu Tingting Gong Leqing Xu Yike Wu Jiyifan Li Yanan Ding Junwei Chow Longzhou Li Guo Ma |
| author_facet | Yue Li Zihan Wang Haiyang Liu Tingting Gong Leqing Xu Yike Wu Jiyifan Li Yanan Ding Junwei Chow Longzhou Li Guo Ma |
| author_sort | Yue Li |
| collection | DOAJ |
| description | Objectives Assess the efficacy and safety profiles of different sodium-glucose cotransporter-2 inhibitors (SGLT2is) as an add-on to metformin in type 2 diabetes mellitus (T2DM) patients.Design Bayesian network meta-analysis.Data sources PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov were searched before 18 December 2024.Eligibility criteria Randomised controlled trials (RCTs) evaluating T2DM patients taking one of 12 SGLT2is as add-on therapy to metformin. Efficacy outcomes focused on glycated haemoglobin (HbA1c) reduction, fasting plasma glucose (FPG) reduction and weight loss (WL). Safety outcomes included adverse events (AEs), serious AEs (SAEs), hypoglycaemia, urinary tract infections (UTI) and genital infections (GI).Data extraction and synthesis Two investigators independently extracted data. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool (V.2.0) for RCTs.Results 23 RCTs involving 9144 patients and 11 SGLT2is were included. Compared with placebo, most SGLT2is reduced HbA1c (mean difference (MD), −0.45~−0.80%), FPG (MD, −0.78~−2.02 mmol/L) and body weight (MD, −0.88~−2.67 kg). Only 10 mg of henagliflozin increased the incidence of AEs, and none of the included interventions increased the risks of SAEs or UTIs. 50 mg of empagliflozin exhibited higher risks of hypoglycaemia. Only 10 mg of empagliflozin increased the risk of GI. According to the surface under the cumulative ranking values, SGLT2is with optimal efficacy and safety were 15 mg of ertugliflozin in HbA1c reduction, 300 mg of canagliflozin in FPG reduction, WL and hypoglycaemia, 400 mg of sotagliflozin in total AEs, 10 mg of ertugliflozin and 150 mg of ipragliflozin in SAEs, 12.5 mg of ipragliflozin in UTI and 1 mg of ertugliflozin in GI.Conclusions As add-on therapy, SGLT2is demonstrated favourable antidiabetic efficacy and acceptable safety. 300 mg of canagliflozin was the best option among the included interventions considering favourable glucose control and WL. Some novel SGLT2is (eg, henagliflozin) exhibited promising efficacy and safety profiles, but more research is needed to validate the findings. |
| format | Article |
| id | doaj-art-fab7b0cf0dbb48ae8aa3212d73a590c2 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-fab7b0cf0dbb48ae8aa3212d73a590c22025-08-20T02:45:42ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-088687Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysisYue Li0Zihan Wang1Haiyang Liu2Tingting Gong3Leqing Xu4Yike Wu5Jiyifan Li6Yanan Ding7Junwei Chow8Longzhou Li9Guo Ma102 Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, China1 Fudan University, Shanghai, Shanghai, ChinaObjectives Assess the efficacy and safety profiles of different sodium-glucose cotransporter-2 inhibitors (SGLT2is) as an add-on to metformin in type 2 diabetes mellitus (T2DM) patients.Design Bayesian network meta-analysis.Data sources PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov were searched before 18 December 2024.Eligibility criteria Randomised controlled trials (RCTs) evaluating T2DM patients taking one of 12 SGLT2is as add-on therapy to metformin. Efficacy outcomes focused on glycated haemoglobin (HbA1c) reduction, fasting plasma glucose (FPG) reduction and weight loss (WL). Safety outcomes included adverse events (AEs), serious AEs (SAEs), hypoglycaemia, urinary tract infections (UTI) and genital infections (GI).Data extraction and synthesis Two investigators independently extracted data. The quality of the included studies was assessed using the Cochrane Risk of Bias Tool (V.2.0) for RCTs.Results 23 RCTs involving 9144 patients and 11 SGLT2is were included. Compared with placebo, most SGLT2is reduced HbA1c (mean difference (MD), −0.45~−0.80%), FPG (MD, −0.78~−2.02 mmol/L) and body weight (MD, −0.88~−2.67 kg). Only 10 mg of henagliflozin increased the incidence of AEs, and none of the included interventions increased the risks of SAEs or UTIs. 50 mg of empagliflozin exhibited higher risks of hypoglycaemia. Only 10 mg of empagliflozin increased the risk of GI. According to the surface under the cumulative ranking values, SGLT2is with optimal efficacy and safety were 15 mg of ertugliflozin in HbA1c reduction, 300 mg of canagliflozin in FPG reduction, WL and hypoglycaemia, 400 mg of sotagliflozin in total AEs, 10 mg of ertugliflozin and 150 mg of ipragliflozin in SAEs, 12.5 mg of ipragliflozin in UTI and 1 mg of ertugliflozin in GI.Conclusions As add-on therapy, SGLT2is demonstrated favourable antidiabetic efficacy and acceptable safety. 300 mg of canagliflozin was the best option among the included interventions considering favourable glucose control and WL. Some novel SGLT2is (eg, henagliflozin) exhibited promising efficacy and safety profiles, but more research is needed to validate the findings.https://bmjopen.bmj.com/content/15/2/e088687.full |
| spellingShingle | Yue Li Zihan Wang Haiyang Liu Tingting Gong Leqing Xu Yike Wu Jiyifan Li Yanan Ding Junwei Chow Longzhou Li Guo Ma Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis BMJ Open |
| title | Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis |
| title_full | Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis |
| title_fullStr | Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis |
| title_full_unstemmed | Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis |
| title_short | Efficacy and safety of 11 sodium-glucose cotransporter-2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin: a Bayesian network meta-analysis |
| title_sort | efficacy and safety of 11 sodium glucose cotransporter 2 inhibitors at different dosages in type 2 diabetes mellitus patients inadequately controlled with metformin a bayesian network meta analysis |
| url | https://bmjopen.bmj.com/content/15/2/e088687.full |
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