Long-Term Efficacy Trajectories of GLP-1 Receptor Agonists: A Systematic Review and Network Meta-Analysis.

IF 3 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Pub Date : 2025-09-23 eCollection Date: 2025-01-01 DOI:10.2147/DMSO.S539822

Zixuan Li, Zhoubo Han, Rong Sun, Xiuping Xuan, Chenghu Huang

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引用次数: 0

Abstract

Purpose: To investigate the long-term efficacy and changing trajectories of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among patients with type 2 diabetes.

Methods: The PubMed, Embase and Cochrane Library databases were searched up to March 2024 to identify randomized controlled trials that assessed the efficacy of GLP-1RAs compared with placebo. To further explore the long-term trajectories of GLP-1RAs, we also conducted subgroup analyses of the placebo-subtracted groups based on the follow-up periods: 12-18 weeks, 24-30 weeks, 48-56 weeks, 68-78 weeks and ≥ 104 weeks.

Results: Fifty-five trials involving 18,876 participants were included in this meta-analysis. GLP-1RAs significantly improved HbA1c levels, body weight, fasting plasma glucose (FPG), systolic blood pressure, and serum lipid levels. GLP-1RAs continuously reduced HbA1c and FPG for at least 104 weeks, with the largest reductions observed at 12-18 weeks (versus placebo, WMD -0.99 [-1.09, -0.89], P < 0.001; -1.56 [-1.82. -1.29], P < 0.001, respectively). However, the reductions in HbA1c and FPG at ≥ 104 weeks were approximately 0.36% and 0.47 mmol/L less than the reductions at 12-18 weeks, respectively. With respect to weight loss, the optimal effect was observed at 24-30 weeks (WMD -2.42 [-2.90, -1.95], P < 0.001), followed by a plateau period. In addition, GLP-1RAs were associated with a greater risk of hypoglycemia and gastrointestinal adverse events.

Conclusion: GLP-1RAs are recommended for long-term treatment of patients with type 2 diabetes due to the persistent improvement in glycemic control and weight loss. However, it is important to account for the weakening effects after 2 years.

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GLP-1受体激动剂的长期疗效轨迹：系统回顾和网络荟萃分析。

目的：探讨胰高血糖素样肽-1受体激动剂（glucagon-like peptide-1 receptor agonists, GLP-1RAs）在2型糖尿病患者中的长期疗效及变化轨迹。方法：检索截至2024年3月的PubMed、Embase和Cochrane图书馆数据库，以确定评估GLP-1RAs与安慰剂疗效的随机对照试验。为了进一步探索GLP-1RAs的长期轨迹，我们还根据随访时间对减安慰剂组进行了亚组分析：12-18周、24-30周、48-56周、68-78周和≥104周。结果：本荟萃分析纳入了55项试验，涉及18876名受试者。GLP-1RAs可显著改善HbA1c水平、体重、空腹血糖（FPG）、收缩压和血脂水平。GLP-1RAs持续降低HbA1c和FPG至少104周，在12-18周时观察到最大的降低（与安慰剂相比，WMD为-0.99 [-1.09,-0.89],P < 0.001; -1.56[-1.82]）。-1.29], P < 0.001)。然而，≥104周时HbA1c和FPG的降低量分别比12-18周时减少约0.36%和0.47 mmol/L。在减肥方面，在24-30周时观察到最佳效果（WMD为-2.42 [-2.90,-1.95],P < 0.001），随后是平台期。此外，GLP-1RAs与低血糖和胃肠道不良事件的高风险相关。结论：GLP-1RAs可持续改善血糖控制和体重减轻，推荐用于2型糖尿病患者的长期治疗。然而，重要的是要考虑到2年后的减弱效应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Pharmacology, Toxicology and Pharmaceutics-Pharmacology

CiteScore

5.90

自引率

6.10%

发文量

431

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed, open access, online journal. The journal is committed to the rapid publication of the latest laboratory and clinical findings in the fields of diabetes, metabolic syndrome and obesity research. Original research, review, case reports, hypothesis formation, expert opinion and commentaries are all considered for publication.