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首页> 外文期刊>Diabetes care >Reduction of Cardiovascular Risk and Improved Estimated Glomerular Filtration Rate by SGLT2 Inhibitors, Including Dapagliflozin, Is Consistent Across the Class: An Analysis of the Placebo Arm of EXSCEL
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Reduction of Cardiovascular Risk and Improved Estimated Glomerular Filtration Rate by SGLT2 Inhibitors, Including Dapagliflozin, Is Consistent Across the Class: An Analysis of the Placebo Arm of EXSCEL

机译：通过SGLT2抑制剂（包括Dapagliflozin）的SGRT2抑制剂的降低和改善的估计肾小球过滤率均一致：对展开的安慰剂臂的分析

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OBJECTIVEThe sodium-glucose cotransporter 2 inhibitors (SGLT2i) empagliflozin and canagliflozin reduce the incidence of major adverse cardiovascular events (MACE), all-cause mortality (ACM), and renal events in cardiovascular outcomes trials, with observational real-world evidence suggesting class effect benefits that include dapagliflozin. We examined the placebo arm of the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) to determine whether the effects of drop-in open-label dapagliflozin on MACE, ACM, and estimated glomerular filtration rate (eGFR) were consistent with the SGLT2i class as a whole.RESEARCH DESIGN AND METHODSSGLT2i drop-in therapy occurred in 10.6% of EXSCEL participants, with 5.2% taking dapagliflozin. Propensity-matched cohorts of SGLT2i users and nonusers (n = 709 per group) were generated on the basis of their characteristics before open-label SGLT2i drop-in or at baseline for participants taking SGLT2i at enrollment and an equivalent study visit for non-SGLT2i users. Time to first adjudicated MACE and ACM was analyzed using Cox regression. eGFR slopes were compared between matched cohorts using a mixed-model repeated-measures analysis.RESULTSIn adjusted analyses, SGLT2i users (compared with nonusers) had a numerically lower risk of MACE (adjusted hazard ratio 0.79 [95% CI 0.49-1.28]), as did dapagliflozin users (0.55 [0.26-1.15]). SGLT2i users had a significantly lower ACM risk (0.51 [0.27-0.95]; dapagliflozin: 0.66 [0.25-1.72]). Compared with nonusers, eGFR slope was significantly better for SGLT2i users overall (+1.78 [95% CI 0.87-2.69] mL/min/1.73 m(2) per year) and for dapagliflozin users (+2.28 [1.01-3.54] mL/min/1.73 m(2) per year).CONCLUSIONSThis post hoc analysis of the placebo arm of EXSCEL supports a beneficial class effect for all SGLT2i, including dapagliflozin, for reduced ACM and less eGFR decline.
机译：客观的钠 - 葡萄糖Cotroangerporter 2抑制剂（SGLT2i）Empagliflozin和蜜胶唑辛可降低主要不良心血管事件（MACE），全因死亡率（ACM）和心血管成果试验中的肾事件的发病率，具有观测的现实世界证据表明阶级效果包括dapagliflozin的好处。我们检查了杂动物事件降低（Excel）的杂交研究的安慰剂臂，以确定下降开放标签Dapagliflozin对钉锤子，ACM和估计的肾小球过滤速率（EGFR）的影响与SGLT2i级别一致全部。搜索设计和方法在10.6％的excel参与者中发生了leglt2i疗法，占Dapagliflozin的5.2％。在开放标签SGLT2I之前或在参与者的参与者处于注册和非SGLT2i的参与者的基准之前，在其特征的基础上产生了SGLT2i用户和非用户（每组N = 709）的群组（每组n = 709）。用户。使用COX回归分析了第一次判决的态度和ACM的时间。使用混合模型重复措施分析比较EGFR斜率。使用混合模型重复措施分析进行匹配的队列。调整后的分析，SGLT2i用户（与非用户相比）的立柱的风险数值较低（调整危险比0.79 [95％CI 0.49-1.28]）， Dapagliflozin用户（0.55 [0.26-1.15]）。 SGLT2i用户的ACM风险显着降低（0.51 [0.27-0.95]; Dapagliflozin：0.66 [0.25-1.72]）。与非用户相比，EGFR斜率总体对SGLT2i用户显着更好（每年+1.78 [95％CI 0.87-2.69] ml / min / 1.73 m（2））和Dapagliflozin用户（+2.28 [1.01-3.54] ml /每年Min / 1.73米（2））。结论excel的安慰剂臂的HOC分析，对所有SGLT2I（包括Dapagliflozin）的受益阶级效果，用于降低ACM和较少的EGFR下降。

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