Background
Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are known to reduce cardiovascular and renal events in type 2 diabetes mellitus (DM) patients. However, no study to date has compared the effect of SGLT-2 inhibitors with that of GLP-1 RAs in type 2 DM patients with chronic kidney disease (CKD). We herein investigated the benefits of SGLT-2 inhibitors and GLP-1 RAs in CKD patients.
Methods
We performed a systematic literature search through July 2020. We selected randomized control trials that compared the risk of major adverse cardiovascular events (MACE) and a composite of renal outcomes. We performed a network meta-analysis to compare SGLT-2 inhibitors with GLP-1 RA indirectly. Risk ratios (RRs) with corresponding 95 % confidence interval (CI) were synthesized.
Results
Fifteen studies were selected with a total of 20,947 patients. SGLT-2 inhibitors led to a risk reduction in MACE (RR [95 % CI]; 0.80 [0.70-0.91]) , but GLP-1 RAs did not (RR 0.89 [0.78-1.00]). Compared to GLP-1 RAs, SGLT-2 inhibitors did not demonstrate a significant difference (RR 0.90 [0.75-1.08]). Similarly, SGLT-2 inhibitors significantly decreased renal events (RR 0.66 [0.58-0.75]), but GLP-1 RAs did not (RR 0.80 [0.90-1.00]). SGLT-2 inhibitors were also associated with a lower risk of renal events compared to GLP-1 RAs (RR 0.73 [0.62-0.87]).
Conclusions
In patients with type 2 DM and CKD, SGLT-2 inhibitors were associated with a decreased risk of cardiovascular and renal events, but GLP-1 RA were not. SGLT-2 inhibitors significantly decreased the risk of renal events compared to GLP-1 RAs.