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Comparative Efficacy of Five SGLT2i on Cardiorenal Events: A Network Meta-analysis Based on Ten CVOTs

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Abstract

Background

The relative efficacy of different sodium-glucose transporter 2 inhibitors (SGLT2i) on cardiorenal outcomes is unclear.

Methods

We included cardiovascular outcome trials (CVOTs) of SGLT2i. The eight endpoints of interest were major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, cardiovascular death (CVD), CVD or hospitalization for heart failure (HHF), HHF, kidney function progression (KFP), and all-cause death (ACD). We conducted a Bayesian network meta-analysis and calculated the surface under the cumulative ranking curve (SUCRA) probability to rank treatments.

Results

We included ten CVOTs involving five SGLT2i. Canagliflozin (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.53–0.77), dapagliflozin (HR 0.70; 95% CI 0.62–0.79), empagliflozin (HR 0.68; 95% CI 0.59–0.78), ertugliflozin (HR 0.70; 95% CI 0.54–0.90), and sotagliflozin (HR 0.66; 95% CI 0.56–0.77) versus placebo reduced HHF, whereas none reduced MI and stroke. Empagliflozin reduced CVD or HHF (HR 0.81; 95% CI 0.67–0.99) and KFP (HR 0.65; 95% CI 0.45–0.93), and dapagliflozin reduced KFP (HR 0.69; 95% CI 0.52–0.92), versus ertugliflozin. Canagliflozin had the greatest SUCRA values for the reduction of MACE, stroke, and HHF, whereas empagliflozin had the greatest SUCRA values for the reduction of MI, CVD, CVD or HHF, KFP, and ACD.

Conclusions

Canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and sotagliflozin versus placebo reduce HHF but none reduces MI and stroke. Canagliflozin is most effective in reducing MACE and HHF, and empagliflozin is most effective in reducing CVD, CVD or HHF, KFP, and ACD. These findings will guide the use of specific SGLT2i in the prevention of different cardiorenal events.

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Authors and Affiliations

  1. Department of General Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China

    Mei Qiu & Hai-Rong Zhou

  2. Department of Cardiology, First Affiliated Hospital of Yangtze University, Jingzhou, 434000, China

    Liang-Liang Ding

Authors
  1. Mei Qiu
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  2. Liang-Liang Ding
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  3. Hai-Rong Zhou
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Corresponding authors

Correspondence to Mei Qiu or Hai-Rong Zhou.

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Funding

This work was supported by the Shenzhen Key Medical Discipline Construction Fund (SZXK063).

Conflict of interest

Mei Qiu, Liang-Liang Ding, and Hai-Rong Zhou have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Ethics approval

Not applicable.

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Not applicable.

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Not applicable.

Availability of Data and Material

All the original data supporting the findings of this study are available in the supplementary appendixes of this paper.

Code availability

The codes used for the data analyses in this study are available from the corresponding author on reasonable request.

Author contributions

Conception and design: MQ. Administrative support: H-RZ. Provision of study materials or patients: MQ, L-LD, and H-RZ. Collection and assembly of data: MQ, L-LD, and H-RZ. Data analysis and interpretation: L-LD, and MQ. Manuscript writing: MQ, L-LD, and H-RZ. Final approval of manuscript: MQ, L-LD, and H-RZ.

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Qiu, M., Ding, LL. & Zhou, HR. Comparative Efficacy of Five SGLT2i on Cardiorenal Events: A Network Meta-analysis Based on Ten CVOTs. Am J Cardiovasc Drugs 22, 69–81 (2022). https://doi.org/10.1007/s40256-021-00484-8

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  • DOI: https://doi.org/10.1007/s40256-021-00484-8

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