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Diabetes Obes Metab. 2017 Mar;19(3):329-335. doi: 10.1111/dom.12821. Epub 2016 Dec 23.

Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: A Bayesian meta-analysis of survival data.

Author information

1
Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK.
2
Precision Health Economics, Vancouver, Canada.
3
Faculty of Medicine, University of British Columbia, Vancouver, Canada.
4
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
5
MSD Ltd, Hoddesdon, UK.
6
Global Epidemiology, Pharmatelligence, Cardiff, UK.
7
Institute of Population Medicine, Cardiff University, Cardiff, UK.
8
School of Medicine, University of Nottingham, Derby, UK.
9
University of Leicester, Leicester, UK.
10
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
11
Royal Liverpool University Hospital, Liverpool, UK.

Abstract

AIM:

To conduct a systematic review and meta-analysis to determine the risk of cardiovascular events and all-cause mortality associated with sulphonylureas (SUs) vs other glucose lowering drugs in patients with T2DM (T2DM).

MATERIALS AND METHODS:

A systematic review of Medline, Embase, Cochrane and clinicaltrials.gov was conducted for studies comparing SUs with placebo or other antihyperglycaemic drugs in patients with T2DM. A cloglog model was used in the Bayesian framework to obtain comparative hazard ratios (HRs) for the different interventions. For the analysis of observational data, conventional fixed-effect pairwise meta-analyses were used.

RESULTS:

The systematic review identified 82 randomized controlled trials (RCTs) and 26 observational studies. Meta-analyses of RCT data showed an increased risk of all-cause mortality and cardiovascular-related mortality for SUs compared with all other treatments combined (HR 1.26, 95% confidence interval [CI] 1.10-1.44 and HR 1.46, 95% CI 1.21-1.77, respectively). The risk of myocardial infarction was significantly higher for SUs compared with dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter-2 inhibitors (HR 2.54, 95% CI 1.14-6.57 and HR 41.80, 95% CI 1.64-360.4, respectively). The risk of stroke was significantly higher for SUs than for DPP-4 inhibitors, glucagon-like peptide-1 agonists, thiazolidinediones and insulin.

CONCLUSIONS:

The present meta-analysis showed an association between SU therapy and a higher risk of major cardiovascular disease-related events compared with other glucose lowering drugs. Results of ongoing RCTs, which should be available in 2018, will provide definitive results on the risk of cardiovascular events and all-cause mortality associated with SUs vs other antihyperglycaemic drugs.

KEYWORDS:

T2DM ; cardiovascular disease; meta-analysis; sulphonylureas; systematic review

PMID:
27862902
DOI:
10.1111/dom.12821
[Indexed for MEDLINE]

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