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To the Editor: We read with interest the letter from Dr Catalá-López [1] commenting on our paper [2]. We performed a network meta-analysis of the reno-protective effects of renin–angiotensin–aldosterone system blockers in type 2 diabetic patients [2]. We combined ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), similar to the previous meta-analysis that compared the combined effects only to placebo [3]. Most importantly, there was very little evidence of any heterogeneity to suggest that ACEIs and ARBs are substantially different. Furthermore, current guidelines for kidney protection in diabetic patients [4] recommend the prescription of either ACEIs or ARBs.
We acknowledge that, because of its sample size, the study by Lewis et al [5] was the greatest contributor to the pooled RR for end-stage renal disease in direct meta-analysis (89.7%). We also acknowledge differences in the design of trials included in the analysis; however, this is quite common when performing a meta-analysis. We did not include the olmesartan trial [6], because this was published after the end of our search (July 2011).
Abbreviations
- ACEI:
-
ACE inhibitor
- ARB:
-
Angiotensin II receptor blocker
References
Catalá-López F (2012) Renoprotective effects of renin–angiotensin–aldosterone system blockers in type 2 diabetes: demystifying multiple treatment comparisons in a network meta-analysis. Diabetologia. doi:10.1007/s00125-012-2619-9
Vejakama P, Thakkinstian A, Lertrattananon D, Ingsathit A, Ngarmukos C, Attia J (2012) Reno-protective effects of renin-angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis. Diabetologia 55:566–578
Casas JP, Chua W, Loukogeorgakis S et al (2005) Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet 366:2026–2033
ADA (2012) Executive summary: standards of medical care in diabetes—2012. Diabetes Care 35(Suppl 1):S4–S10
Lewis EJ, Hunsicker LG, Clarke WR et al (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860
Imai E, Chan JC, Ito S et al (2011) Effects of olmesartan on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy: a multicentre, randomised, placebo-controlled study. Diabetologia 54:2978–2986
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All three authors were responsible for the conception and design of the manuscript, drafting the article and revising it critically for important intellectual content. All authors approved the version to be published.
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Vejakama, P., Thakkinstian, A. & Attia, J. Renoprotective effects of renin–angiotensin–aldosterone system blockers in type 2 diabetes: demystifying multiple treatment comparisons in a network meta-analysis. Reply to Catalá-López F [letter]. Diabetologia 55, 2549–2550 (2012). https://doi.org/10.1007/s00125-012-2628-8
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DOI: https://doi.org/10.1007/s00125-012-2628-8