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达格列净和阿卡波糖临床疗效间接比较的系统性综述和Meta分析

Indirect comparison of clinical efficacy between dapagliflozin and acarbose in type 2 diabetes mellitus: a systematic review and Meta-analysis

摘要:

目的 评价达格列净和阿卡波糖治疗2型糖尿病(T2DM)的临床疗效.方法 通过计算机检索PubMed、万方等数据库,收集截至2016年4月发表的单独使用达格列净或阿卡波糖,并单独以安慰剂作为对照的所有随机对照研究,提取糖化血红蛋白(HbA1c)、体重和收缩压(SBP)作为评价指标进行Meta分析.采用R语言Meta分析包,运用加权均数差(WMD)进行评价指标的合并、敏感性分析、发表偏倚分析,并采用Bucher法进行达格列净与阿卡波糖降HbA1c、体重和SBP的间接比较.结果 共14项研究纳入Meta分析.与安慰剂相比,达格列净降低HbA1c的WMD=-0.59%[95%CI :(-0.67,-0.51)%]、降体重的WMD=-1.62[(-1.80,-1.43) kg]、降SBP的WMD=-2.60 mmHg [(-3.01,-2.19) mmHg(1 mmHg=0.133 kPa),均P<0.001];阿卡波糖降HbA1c的WMD=-0.52%[(-0.64,-0.40)% ,P<0.001]、降体重的WMD=-0.70 kg [(-1.10,-0.29) kg,P<0.001]、降SBP的WMD=-0.13 mmHg [(-2.54, 2.28) mmHg,P>0.05].以安慰剂作为中间变量,与阿卡波糖间接比较,达格列净降HbA1c的WMD=-0.07%[(-0.21,0.07)% ,P=0.341]、降体重的WMD=-0.92 kg [(-1.37,-0.47) kg,P<0.001]、降SBP的WMD=-2.47 mmHg [(-4.91,-0.03) mmHg,P<0.05].结论 达格列净降HbA1c的效果与阿卡波糖相当,但降体重和SBP的效果优于阿卡波糖.

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Objective To compare the clinical efficacy between dapagliflozin and acarbose in type 2 diabetes mellitus (T2DM) by systematic review and Meta-analysis. Methods Eligible randomized controlled trials were searched to compare dapagliflozin or acarbose monotherapy with placebo from PubMed, the Cochrane Library, Web of Science, CNKI Database, Wan Fang Database and VIP Database until 30 April 2016. Meta-analysis were conducted to evaluate the levels of HbA1c, body weight and systolic blood pressure (SBP) after treatment of dapagliflozin, acarbose and placebo. Bucher method was applied to convert the summary estimates from Meta-analysis into weighted-mean-difference ( WMD ). Results A total of 21 studies were included in the Meta-analysis. HbA1c, body weight and SBP decreased 0.59% [95%CI:(-0.67, -0.51)% , P<0.001], 1.62(-1.80, -1.43) kg, P<0.001] and 2.60(-3.01, -2.19) mmHg (1 mmHg=0.133 kPa), P<0.001] respectively in Dapagliflozin monotherapy than those in placebo therapy; HbA1c, body weight and SBP decreased 0.52% (-0.64%, -0.40%), P<0.001], 0.7 kg [(-1.10, -0.29) kg, P<0.001] and 0.13 mmHg [(-2.54, 2.28) mmHg, P>0.05] respectively in acarbose monotherapy than those in placebo therapy. By indirect comparison using placebo as a common comparator, HbA1cdecreased 0.07% in dapagliflozin monotherapy than that in acarbose monotherapy, but the difference wasn't significant [(-0.21, 0.07)%, P=0.341]; Additionally, body weight and SBP decreased 0.92[(-1.37,-0.47) kg, P<0.001] and 2.47 [(- 4.91, - 0.03) mmHg, P<0.05] respectively in dapagliflozin monotherapy than those in acarbose monotherapy. Conclusions The monotherapy efficacy of dapagliflozin in HbA1creduction is similar to that of acarbose, but the monotherapy effects of dapagliflozin in weight loss and SBP reduction are better than those of acarbose.

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