非格列酮与卡那格列净对慢性肾脏病和 2 型糖尿病患者的疗效比较:匹配调整后的间接比较

D. Cherney, Kerstin Folkerts, P. Mernagh, Mateusz Nikodem, Joerg Pawlitschko, P. Rossing, Neil Hawkins
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引用次数: 0

摘要

本研究旨在填补关于非格列酮与SGLT2i在慢性肾脏病(CKD)和2型糖尿病(T2D)患者中的相对疗效的证据空白。研究选择卡格列净作为 SGLT2i 类药物的代表。研究使用了两项非格列酮随机对照试验(RCT)(FIDELIO-DKD 和 FIGARO-DKD)的患者水平数据,以及一项卡格列净随机对照试验 CREDENCE 的汇总数据。为了考虑每项非格列酮试验与 CREDENCE 之间存在的研究间异质性,对每项非格列酮研究与 CREDENCE 的一系列疗效结果进行了匹配调整后的间接比较。对这些结果进行了荟萃分析,从而估算出非格列酮与卡格列净的相对疗效。就心肾综合终点而言,非格列酮与卡格列净的危险比(HR)为 1.07(95% CI:0.83 至 1.36)。全因死亡率、终末期肾病和心血管死亡的相应HR分别为0.99(95% CI:0.73至1.34)、1.03(95% CI:0.68至1.55)和0.94(95% CI:0.64至1.37)。在整个主要分析和一系列敏感性分析中,均未发现明显的统计学差异。根据这项研究,使用大样本数据并对纳入的 RCT 基线特征之间有意义的差异进行调整后,没有统计学意义上的显著证据表明,在治疗 T2D 患者的 CKD 方面,非格列酮与卡格列净的疗效存在差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative Efficacy of Finerenone versus Canagliflozin in Patients with Chronic Kidney Disease and Type 2 Diabetes: A Matching-Adjusted Indirect Comparison
This study aimed to close an evidence gap concerning the relative efficacy of finerenone versus SGLT2is in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Canagliflozin was selected as a proxy for the SGLT2i class. Patient-level data of two randomized controlled trials (RCTs) of finerenone (FIDELIO-DKD and FIGARO-DKD) were used alongside aggregated data from CREDENCE, an RCT of canagliflozin. To account for meaningful between-study heterogeneity between each finerenone trial and CREDENCE, a matching-adjusted indirect comparison of a range of efficacy outcomes was undertaken for each finerenone study versus CREDENCE. These results were meta-analyzed, enabling the estimation of the relative effects of finerenone against canagliflozin. For the cardiorenal composite endpoint, the hazard ratio (HR) comparing finerenone to canagliflozin was 1.07 (95% CI: 0.83 to 1.36). The corresponding HRs for all-cause mortality, end-stage kidney disease and cardiovascular death were 0.99 (95% CI: 0.73 to 1.34), 1.03 (95% CI: 0.68 to 1.55) and 0.94 (95% CI: 0.64 to 1.37), respectively. The absence of statistically significant differences was consistent throughout the main analysis and a range of sensitivity analyses. Based on this study, using a large sample of data and adjusted for meaningful differences between the baseline characteristics of the included RCTs, there was no statistically significant evidence indicating a difference in the efficacy of finerenone compared to canagliflozin in the treatment of CKD in patients with T2D.
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