Andrea Saglietto, Giulio Falasconi, Diego Penela, Pietro Francia, Arunashis Sau, Fu Siong Ng, Veronica Dusi, Davide Castagno, Fiorenzo Gaita, Antonio Berruezo, Gaetano Maria De Ferrari, Matteo Anselmino
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Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug-specific benefit in reducing atrial fibrillation (AF) occurrence.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To perform a meta-analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo.</p>\n </section>\n \n <section>\n \n <h3> Methods and Results</h3>\n \n <p>Ten RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow-up of 68 months. A random effect meta-analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40–.85), with low heterogeneity across the studies (<i>I</i><sup>2</sup> 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23–1.24, <i>I</i><sup>2</sup> 0%; subcutaneous: RR .59, 95% CI .39–.91, <i>I</i><sup>2</sup> 0%; <i>p</i>-value .83). In addition, meta-regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (<i>p</i>-value .14) and body mass index (BMI) (<i>p</i>-value .60).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Semaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. 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引用次数: 0
摘要
背景：胰高血糖素样肽-1受体激动剂（GLP-1 RAs）是新型抗高血糖药物，已被证实对心血管风险较高的糖尿病和非糖尿病患者有益。尽管该类药物对心律失常风险的影响是中性的，但有关semaglutide的数据表明，该类药物在降低心房颤动（AF）发生率方面可能具有特异性优势：对随机临床试验（RCT）进行荟萃分析，评估与安慰剂相比，接受塞马鲁肽治疗的患者发生房颤的风险：分析共纳入了十项随机临床试验。研究对象包括12651名患者（7285人接受了舍马鲁肽治疗，5366人接受了安慰剂治疗），中位随访时间为68个月。研究采用随机效应荟萃分析模型对房颤发生的相对风险（RR）进行汇总。塞马鲁肽可将房颤风险降低 42% (RR .58, 95% CI .40-.85)，各项研究的异质性较低（I2 0%）。在亚组分析中，口服与皮下注射之间没有差异（口服：RR .53，95% CI .23-1.24，I2 0%；皮下注射：RR .59，95% CI .3-1.24，I2 0%）：RR .59，95% CI .39-.91，I2 0%；P 值 .83）。此外，元回归分析未显示基线研究协变量的任何潜在影响，尤其是糖尿病患者比例（P值.14）和体重指数（BMI）（P值.60）：结论：与安慰剂相比，塞马鲁肽能明显降低冠心病高危人群（主要是受2型糖尿病影响的人群）42%的房颤发生率。这一效果似乎与给药途径（口服或皮下注射）、是否存在潜在糖尿病和体重指数无关。
Glucagon-like peptide-1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta-analysis
Background
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are new anti-hyperglycaemic drugs with proven cardiovascular (CV) benefit in diabetic and non-diabetic patients at high CV risk. Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug-specific benefit in reducing atrial fibrillation (AF) occurrence.
Objective
To perform a meta-analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo.
Methods and Results
Ten RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow-up of 68 months. A random effect meta-analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40–.85), with low heterogeneity across the studies (I2 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23–1.24, I2 0%; subcutaneous: RR .59, 95% CI .39–.91, I2 0%; p-value .83). In addition, meta-regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (p-value .14) and body mass index (BMI) (p-value .60).
Conclusions
Semaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. This effect appears to be consistent independently of the route of administration of the drug (oral or subcutaneous), the presence of underlying diabetes and BMI.
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EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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