Cardiovascular and kidney outcomes of combination therapy with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists in patients with type 2 diabetes and chronic kidney disease: A systematic review and network meta-analysis. (December 2022)

• Record Type: Journal Article
• Authors: Tsukamoto, Shunichiro; Morita, Ryutaro; Yamada, Takayuki; Urate, Shingo; Azushima, Kengo; Uneda, Kazushi; Kobayashi, Ryu; Kanaoka, Tomohiko; Wakui, Hiromichi; Tamura, Kouichi
• Is Part Of: Diabetes research and clinical practice. Volume 194(2022)
• Publication Date: 2022-12
• Subjects: Sodium-glucose cotransporter-2 inhibitors -- Mineralocorticoid receptor antagonist -- Chronic kidney disease -- Diabetes -- Cardiovascular disease -- Hyperkalemia; T2D type 2 diabetes -- CKD chronic kidney disease -- ESKD end-stage kidney disease -- CV cardiovascular -- RAS renin-angiotensin system -- SGLT-2 sodium-glucose cotransporter-2 -- MRA mineralocorticoid receptor antagonist -- PRISM Preferred Reporting Items for Systematic Reviews and meta-Analyses -- PROSPERO International Prospective Register of Systematic Reviews -- eGFR estimated glomerular filtration rate -- UACR urinary albumin/creatinine ratio -- Cr creatinine -- RCT randomized controlled trial -- MI myocardial infarction -- HF heart failure -- AE adverse event -- RR risk ratio -- CI confidence interval; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2022.110161
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular (CV) event in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, little evidence pertains to the benefits of their combined use. Methods: We systematically searched the PubMed, MEDLINE, EMBASE, and Cochrane Library databases through July 2022. We selected randomized controlled trials comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination therapy, with placebo in patients with T2D and CKD. We performed a network meta -analysis to indirectly compare the treatments. The primary outcome was a composite of CV events. Results: Eight studies were selected with 36, 186 patients. The primary outcome was significantly improved in the combination therapy group compared with the other groups (RR [95% CI]; vs SGLT-2 inhibitors, 0.76 [0.60; 0.96]; vs MRAs, 0.66 [0.53; 0.82]; vs placebo, 0.58 [0.47; 0.73]). Additionally, the combination therapy was associated with a considerable reduction in the risk of hyperkalemia (RR vs MRA, 0.43 [0.23; 0.79]). Conclusion: Combination of SGLT-2 inhibitors and MRAs potentially reduced CV events compared with SGLT-2 inhibitors or MRAs alone. This combination may be a candidate treatment strategy for patients with T2D and CKD.