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DPP-4在2型糖尿病中的胃肠道不良事件回顾

Purpose: The purpose of this study was to systematically evaluate the effect of dipeptidyl peptidase 4 inhibitors on gastrointestinal adverse events in patients with type 2 diabetes.
 
Methods: MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception through April 28, 2016. Randomized controlled trials that compared dipeptidyl peptidase 4 inhibitor–based therapies with placebo and other hypoglycemic agents in type 2 diabetes were included.The duration of studies was at least 4 weeks.
 
Findings: A total of 165 randomized controlled trials and 122,072 patients were included in the study. Dipeptidyl peptidase 4 inhibitors did not increase the incidence of gastrointestinal adverse events after the treatment with alogliptin (odds ratio [OR] = 0.83;95% CI, 0.59–1.15), linagliptin (OR = 1.11; 95% CI,0.92–1.35), saxagliptin (OR = 0.96; 95% CI, 0.80–1.15), sitagliptin (OR = 0.95; 95% CI, 0.64–1.14),teneligliptin (OR = 1.50; 95% CI, 0.81–2.77), and vildagliptin (OR = 0.80; 95% CI, 0.63–1.01) compared with placebo. Compared with glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors significantly decreased the incidence of gastrointestinal adverse events with alogliptin (OR = 0.26; 95% CI, 0.15-0.44), linagliptin (OR = 0.43;95% CI, 0.25–0.74), saxagliptin (OR = 0.28; 95% CI, 0.17–0.46), sitagliptin (OR = 0.24; 95% CI, 0.17–0.35), and vildagliptin (OR = 0.27; 95% CI, 0.18–0.41). Dipeptidyl peptidase 4 inhibitors were not associated with an increased risk of gastrointestinal adverse events relative to metformin and α-glucosidase inhibitors, respectively.
 
Implications: The network meta-analysis found that compared with glucagon-like peptide 1 receptor agonists, metformin, and α-glucosidase inhibitor, dipeptidyl peptidase 4 inhibitors are associated with a lower incidence of gastrointestinal adverse events.