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Diabetes Obes Metab:治疗2型糖尿病 众多GLP-1RA排座次

2017-04-11 吴刚 环球医学资讯

目前关于GLP-1类药物的系统评价很多,但是很少有像这个研究比较那么全面的,该研究将每个GLP-1类药物的特点都进行分析,非常值得参考。

2017年4月,发表在《Diabetes Obes Metab》的一项由英国科学家进行的系统评价和混合治疗比较分析,考察了胰高血糖素样肽-1受体激动剂(GLP-1RA)在2型糖尿病中的有效性和安全性。

目的:旨在比较GLP-1RA在2型糖尿病中的有效性和安全性。

材料和方法:研究人员电子检索了截至2016年6月3日的发表的随机临床试验,这些随机临床试验持续进行24~32周,将一种GLP-1RA(阿必鲁肽、杜拉鲁肽、每天两次艾塞那肽和每周一次艾塞那肽、利拉鲁肽、利西拉肽、索马鲁肽、他司鲁肽)与安慰剂或另一种GLP-1RA进行了比较。使用混合治疗比较Meta分析评估了血管代谢和安全性结局的数据。

结果:总共34项试验(14464名参与者)符合入组标准,无索马鲁肽的发表数据可用。与安慰剂相比,所有的GLP-1RA都可降低糖化血红蛋白和空腹血糖(FPG)水平(降低范围从利西拉肽的-0.55%和-0.73mmol/L到杜拉鲁肽的-1.21%和-1.97mmol/L)。短效组(每天两次艾塞那肽和利西拉肽)或长效组(阿必鲁肽、杜拉鲁肽、每周一次艾塞那肽、利拉鲁肽和他司鲁肽)内没有差异。与艾塞那肽每天两次相比,杜拉鲁肽治疗与最多的糖化血红蛋白和FPG降低相关(0.51%和1.04mmol/L),其次是利拉鲁肽(0.45%和0.93mmol/L)和每周一次艾塞那肽(0.38%和0.85mmol/L);当这三种药物与利西拉肽相比时,观察到相似的降低。与安慰剂相比,除了阿必鲁肽外,所有的GLP-1RA都会降低体重,并增加低血糖和胃肠道副反应风险。除了杜拉鲁肽和他司鲁肽外,所有药物都会降低收缩压。当所有的GLP-1RA各自相比时,在体重减轻、血压降低或低血糖风险上,都未观察到具有临床意义的差异。阿必鲁肽具有最低的恶心和腹泻风险,艾塞那肽每周一次具有最低的呕吐风险。

结论:本分析中的RCT表明,与安慰剂相比,所有的GLP-1RA都会改善血糖控制、降低体重,并增加不良胃肠道症状的风险。虽然短效药物各自相比或长效药物各自相比时没有差异,但是在降低糖化血红蛋白和空腹血糖水平上,杜拉鲁肽、利拉鲁肽和每周一次艾塞那肽都优于每天两次艾塞那肽和利西拉肽。这三种药物间,在低血糖上无差异,而艾塞那肽每周一次具有最低的呕吐风险。当选择GLP-1RA时,应该考虑这些结果,以及患者偏好和个体化目标。

原文出处
Htike ZZ,et al.Efficacy and safety of glucagon-like peptide-1 receptor agonists in type 2 diabetes: A systematic review and mixed-treatment comparison analysis.Diabetes Obes Metab. 2017 Apr;19(4):524-536. doi: 10.1111/dom.12849. Epub 2017 Feb 17.

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    2017-07-22 一闲
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    2017-09-12 360611848
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    2018-02-15 guojianrong
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    2017-04-13 yibei
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