Cardiovascular events and all-cause mortality associated with sulfonylureas compared to other antihyperglycaemic drugs: A Bayesian meta-analysis of survival data.

AIM:

Our aim was to conduct a systematic review and meta-analysis to determine the risk of cardiovascular events and all-cause mortality associated with sulfonylureas versus other antihyperglycaemic drugs in patients with type 2 diabetes.

MATERIALS AND METHODS:

A systematic review of Medline, Embase, Cochrane, and clinicaltrials.gov was conducted comparing sulfonylurea to placebo or other antihyperglycaemic drugs in patients with type 2 diabetes. A cloglog model was employed in the Bayesian framework to obtain comparative hazard ratios between interventions. For the analysis of observational data, conventional fixed-effect pairwise meta-analyses were employed.

RESULTS:

The systematic review identified 82 randomized controlled trials (RCTs) and 26 observational studies. Meta-analyses of RCT data showed an increased risk of all-cause mortality and cardiovascular related mortality for sulfonylureas compared to all other treatments combined (HR 1 · 26, 95% CI 1 · 10-1 · 44 and HR 1 · 46, 95% CI 1 · 21-1 · 77, respectively). The risk of myocardial infarction was significantly higher for sulfonylureas compared to DPP-4 inhibitors and SGLT-2 inhibitors (HR 2 · 54, 95% CI 1 · 14-6 · 57 and HR 41 · 80, 95% CI 1 · 64-360 · 4, respectively). The risk of stroke was significantly higher for sulfonylureas compared to DPP-4 inhibitors, GLP-1 agonists, TZDs, and insulin.

CONCLUSION:

This meta-analysis shows an association between sulfonylurea therapy and a higher risk of major cardiovascular disease-related events compared to other antihyperglycaemic drugs. Results of ongoing RCTs, which should be available in 2018, will provide definitive results on the risk of cardiovascular events and all-cause mortality associated with sulfonylureas versus other antihyperglycaemic drugs.


Authors: E Druyts, C Balijepalli, R Das, G Siliman, K Thorlund, K Toor, EJ Mills, et al

Source: Diabetes Obes Metab.

Publication Year: 2016