EFFECTIVENESS OF SGLT2I RELATIVE TO OTHER SECOND-LINE DRUGS ON CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF REAL-WORLD DATA

Abstract

The sodium-glucose cotransporter-2 inhibitors (SGLT2i) can reduce risk of heart failure and composite cardiovascular outcomes. However, the effects of SGLT2i on chronic kidney disease (CKD) remain unclear. This systematic review and meta-analysis were conducted to evaluate the effectiveness of SGLT2i relative to other second-line glucose lowering drugs (i.e., thiazolidinediones, glucagon-like peptide 1, dipeptidyl peptidase-4 inhibitors and sulfonylurea) on CKD in type 2 diabetes mellitus (T2DM) patients. Relevant studies were identified from Medline and SCOPUS databases through July, 2023. Any cohort studies of T2DM that apply the propensity score method to compare the effect of SGLT2i with other second line drugs on CKD were included. Data were independently extracted by 2 reviewers. Direct meta-analysis was applied for pooling adjusted hazard ratio (HR) from propensity score. Meta-regression analysis was applied to explore sources of heterogeneity. Eight cohorts with 13 sub-cohorts with 400,211 patients were included. The results showed that HRs (95% CI) of SGLT2i was 0.53 (0.43, 0.66), with high degree of heterogeneity (I2 = 91.75%; Q test p-value = <0.001). It means that the risk of CKD was 47% statistically significant lower in SGLT2i treated subjects than other second line drugs.