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二肽基肽酶4抑制剂在2型糖尿病中的胃肠道不良事

ABSTRACT
Purpose: The purpose of this study was to system一 atically evaluate the effect of dipeptidyl peptidase 4 inhibitors on gastrointestinal adverse events in pa一 tients with type 2 diabetes.
Methods: MEDLINE, Embase, the Cochrane Li一brary, and ClinicalTrials.gov  were : searched from inception through April 28, 2016. Randomized con一trolled trials that compared dipeptidyl
peptidase 4 inhibitor一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, 0.59一1.15), linagliptin (OR= 1.11; 95% CI, 0.92一1.35), saxagliptin (OR = 0.96; 95% CI, 0.80一1.15), sitagliptin (OR = 0.95; 95% CI, 0.64一1.14), teneligliptin (OR = 1.50; 95% CI, 0.81一2.77), and vildagliptin (OR = 0.80; 95% CI, 0.63一1.01) com一pared with placebo. Compared with glucagon一like
peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors significantly decreased the incidence of gastrointestinal adverse events with alogliptin (OR = 0.26; 95% CI, 0.15一0.44), linagliptin (OR = 0.43;95% CI, 0.25一0.74), saxagliptin (OR = 0.28; 95% CI, 0.17一0.46), sitagliptin (OR = 0.24; 95% CI, 0.17一 0.35), and vildagliptin (OR = 0.27; 95% CI, 0.18一0.41). Dipeptidyl peptidase 4 inhibitors were not associated with an increased risk of gastrointestinal adverse events relative to metformin and o 一glucosidase inhibitors, respectively.
Implications:The network meta一analysis found that compared with glucagon一like peptide 1 receptor agonists, metformin, and a一glucosidase inhibitor, di一 peptidyl peptidase 4 inhibitors are associated with a lower incidence of gastrointestinal adverse events.