SGLT-2 Inhibitors: The Best Bet Among New T2Diabetes Drugs

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Sodium-glucose cotransporter 2 (SGLT-2) inhibitors came out on top in a large meta-analysis of clinical trials that compared the newer classes of diabetes drugs head-to-head in terms of mortality, cardiovascular, and safety endpoints.

                Dipeptidyl peptidase 4 (DPP-4) inhibitors fared the worst in the analysis, and glucagon-like peptide 1 (GLP-1) agonists were in the middle, reported Sean Zheng, BM BCh, of the Royal Brompton Hospital in London, and colleagues.
                 "No cardiovascular outcome trials have directly compared the efficacy of these classes. When no head-to-head trial exists, network meta-analysis can be used to estimate the effect," Zheng's group wrote in the Journal of the American Medical Association. "Of the three classes tested, SGLT-2 inhibition may be preferred over the incretin-based therapies based on their association with lower mortality and their favorable adverse event profile."

                 Compared with control groups, SGLT-2 inhibitors were associated with reduced all-cause mortality (hazard ratio 0.80, 95% CI 0.71 to 0.89), as were GLP-1 agonists (HR 0.88, 95% CI 0.81 to 0.94). However, DPP-4 inhibitors were not (HR 1.02, 95% CI 0.94 to 1.11).

                Compared with DPP-4 inhibitors, both SGLT-2 inhibitors and GLP-1 agonists were associated with reduced all-cause mortality (HR for SGLT-1 inhibitors 0.78, 95% CI 0.68 to 0.90; HR for GLP-1 agonists 0.86, 95% CI 0.77 to 0.96). There was no significant difference when SGLT-2 inhibitors and GLP-1 agonists were compared with each other.