MedicalResearch.com Interview with:
Sean Lee Zheng BM BCh MA MRCP
King’s College Hospital London
British Heart Foundation Centre of Research Excellence
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The growing prevalence of type 2 diabetes and its associated burden on cardiovascular disease is a global problem. A number of drug treatments effective in lowering blood glucose are now available, with the three latest drug classes developed being the DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors. While the use of medications from these three classes are increasing, it remains unknown how they compare in lowering the risk of death or cardiovascular disease. This leads to clinical uncertainty when it comes to introducing new medicines for our patients. Our study aimed to use data from randomized clinical trials in a network meta-analysis, allowing these three drug classes to be compared with one another.
Our study, which included 236 studies enrolling 176310 participants, showed that the use of SGLT-2 inhibitors or GLP-1 agonists were associated with a lower risk of death than with DPP-4 inhibitors. SGLT-2 inhibitors had additional beneficial effects on heart failure events compared with the other two drug classes.
MedicalResearch.com: What should readers take away from your report?
Response: In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 agonists reduce your risk of death compared with DPP-4 inhibitors. SGLT-2 inhibitors may have additional benefits on your risk of cardiovascular disease, specifically future heart failure events.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Although preferable, it is unlikely that drugs from these three classes will be tested against each other in well-powered randomized clinical trials. Real world data with long-term follow-up will be important to provide evidence and support for the conclusions drawn from our study. In fact, results from the CVD-REAL study, a prospective observational study with propensity-matching, has shown similar findings to ours. Long-term data is essential to demonstrate whether these mortality benefits persist, and that these drugs are safe.
Zheng SL, Roddick AJ, Aghar-Jaffar R, et al. Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 DiabetesA Systematic Review and Meta-analysis. JAMA. 2018;319(15):1580–1591. doi:10.1001/jama.2018.3024
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