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Indirect comparison of glucagon like peptide-1 receptor agonists regarding cardiovascular safety and mortality in patients with type 2 diabetes mellitus: network meta-analysis.
Cardiovasc Diabetol. 2020 Jun 22; 19(1):96.CD

Abstract

BACKGROUND

The cardiovascular outcome trials (CVOTs) have shown that glucagon like peptide-1 receptor agonists (GLP1RAs) have varying degrees of cardiovascular (CV) safety in patients with type 2 diabetes mellitus (T2DM.) The lack of any head-to-head comparative trials among GLP1RAs urged the need for an indirect comparison of these agents. Therefore, this study was conducted to indirectly compare the CV safety and mortality effects among different GLP1RAs in patients with T2DM using network meta-analysis (NMA).

METHODS

Medline was searched to identify GLP1RA CVOTs to date. The outcomes of interest were CV death, myocardial infarction (IM), stroke, and death from any cause. An NMA with binomial likelihood logit link model was used for the binary outcomes. We conducted both fixed effects and random effects models for each outcome, and selected the best model based on the deviance information and the average posterior residual deviance. This NMA was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA-NMA).

RESULTS

A total of seven GLP1RA CVOTs were included having 56,004 patients. The NMA results showed that oral semaglutide was statistically better than exenatide (OR 0.47, 95% CI 0.21-0.99), dulaglutide (OR 0.46, 95% CI 0.20-0.97), albiglutide (OR 0.45, 95% CI 0.19-0.97), lixisenatide (OR 0.43, 95% CI 0.19-0.92) in reducing CV death events. No significant differences were detected between most of the treatments regarding reducing death from any cause, MI and stroke events. The ranking results showed that oral semaglutide had the highest probability to be ranked first (> 90%) in reducing CV death and death from any cause. Moreover, once weekly semaglutide had the highest probability to be ranked first in reducing MI and stroke events.

CONCLUSION

The GLP1RAs have shown significant benefits in terms of CV safety. The indirect comparison and ranking probability results have shown that one weekly semaglutide and oral semaglutide seems to be the preferred option in patients with T2DM and established or at high risk of CVD. This result can aid health care providers, pharmacy and therapeutics committees in hospitals, and insurance companies when deciding which GLP1RA to start or add to their formulary.

Authors+Show Affiliations

Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia.Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. oalmohammed@ksu.edu.sa.Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia.Saudi Food and Drug Authority, Riyadh, Saudi Arabia.Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32571416

Citation

Alfayez, Osamah M., et al. "Indirect Comparison of Glucagon Like Peptide-1 Receptor Agonists Regarding Cardiovascular Safety and Mortality in Patients With Type 2 Diabetes Mellitus: Network Meta-analysis." Cardiovascular Diabetology, vol. 19, no. 1, 2020, p. 96.
Alfayez OM, Almohammed OA, Alkhezi OS, et al. Indirect comparison of glucagon like peptide-1 receptor agonists regarding cardiovascular safety and mortality in patients with type 2 diabetes mellitus: network meta-analysis. Cardiovasc Diabetol. 2020;19(1):96.
Alfayez, O. M., Almohammed, O. A., Alkhezi, O. S., Almutairi, A. R., & Al Yami, M. S. (2020). Indirect comparison of glucagon like peptide-1 receptor agonists regarding cardiovascular safety and mortality in patients with type 2 diabetes mellitus: network meta-analysis. Cardiovascular Diabetology, 19(1), 96. https://doi.org/10.1186/s12933-020-01070-z
Alfayez OM, et al. Indirect Comparison of Glucagon Like Peptide-1 Receptor Agonists Regarding Cardiovascular Safety and Mortality in Patients With Type 2 Diabetes Mellitus: Network Meta-analysis. Cardiovasc Diabetol. 2020 Jun 22;19(1):96. PubMed PMID: 32571416.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indirect comparison of glucagon like peptide-1 receptor agonists regarding cardiovascular safety and mortality in patients with type 2 diabetes mellitus: network meta-analysis. AU - Alfayez,Osamah M, AU - Almohammed,Omar A, AU - Alkhezi,Omar S, AU - Almutairi,Abdulaali R, AU - Al Yami,Majed S, Y1 - 2020/06/22/ PY - 2020/02/09/received PY - 2020/06/16/accepted PY - 2020/6/24/entrez PY - 2020/6/24/pubmed PY - 2020/6/24/medline KW - Cardiovascular disease KW - Diabetes mellitus KW - Heart failure KW - Meta-analysis KW - Myocardial infarction KW - Stroke KW - Type 2 SP - 96 EP - 96 JF - Cardiovascular diabetology JO - Cardiovasc Diabetol VL - 19 IS - 1 N2 - BACKGROUND: The cardiovascular outcome trials (CVOTs) have shown that glucagon like peptide-1 receptor agonists (GLP1RAs) have varying degrees of cardiovascular (CV) safety in patients with type 2 diabetes mellitus (T2DM.) The lack of any head-to-head comparative trials among GLP1RAs urged the need for an indirect comparison of these agents. Therefore, this study was conducted to indirectly compare the CV safety and mortality effects among different GLP1RAs in patients with T2DM using network meta-analysis (NMA). METHODS: Medline was searched to identify GLP1RA CVOTs to date. The outcomes of interest were CV death, myocardial infarction (IM), stroke, and death from any cause. An NMA with binomial likelihood logit link model was used for the binary outcomes. We conducted both fixed effects and random effects models for each outcome, and selected the best model based on the deviance information and the average posterior residual deviance. This NMA was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA-NMA). RESULTS: A total of seven GLP1RA CVOTs were included having 56,004 patients. The NMA results showed that oral semaglutide was statistically better than exenatide (OR 0.47, 95% CI 0.21-0.99), dulaglutide (OR 0.46, 95% CI 0.20-0.97), albiglutide (OR 0.45, 95% CI 0.19-0.97), lixisenatide (OR 0.43, 95% CI 0.19-0.92) in reducing CV death events. No significant differences were detected between most of the treatments regarding reducing death from any cause, MI and stroke events. The ranking results showed that oral semaglutide had the highest probability to be ranked first (> 90%) in reducing CV death and death from any cause. Moreover, once weekly semaglutide had the highest probability to be ranked first in reducing MI and stroke events. CONCLUSION: The GLP1RAs have shown significant benefits in terms of CV safety. The indirect comparison and ranking probability results have shown that one weekly semaglutide and oral semaglutide seems to be the preferred option in patients with T2DM and established or at high risk of CVD. This result can aid health care providers, pharmacy and therapeutics committees in hospitals, and insurance companies when deciding which GLP1RA to start or add to their formulary. SN - 1475-2840 UR - https://www.unboundmedicine.com/medline/citation/32571416/Indirect_comparison_of_glucagon_like_peptide-1_receptor_agonists_regarding_cardiovascular_safety_and_mortality_in_patients_with_type_2_diabetes_mellitus:_network_meta-analysis L2 - https://cardiab.biomedcentral.com/articles/10.1186/s12933-020-01070-z DB - PRIME DP - Unbound Medicine ER -
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