SGLT2 inhibitors ‘best choice’ for reducing AKI risk vs other glucose-lowering drugs
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For patients with type 2 diabetes, SGLT2 inhibitors conferred a lower risk of developing AKI than use of GLP-1 receptor agonists or dipeptidyl peptidase-4 inhibitors, according to a network meta-analysis of clinical trials.
Min Zhao, MD, of the school of public health at Guangxi Medical University in China, and colleagues contended that it is “critically important” clinicians gain a solid understanding of the differences in AKI risk between the three drugs to improve prescribing practices.
“However, knowledge of the comparative effects of these three classes of glucose-lowering drugs on risk of AKI is limited because few head-to-head trials have been performed,” the researchers wrote. “Unlike standard pairwise meta-analysis (comparing two treatments directly), a network meta-analysis allows us to compare multiple interventions simultaneously in a single analysis by combining both direct head-to-head trials and indirect comparison between the interventions across a network of studies. This enables us to estimate the comparative effects of DPP4 inhibitors, GLP-1RAs, and SGLT2 inhibitors on risk of AKI, in absence of head-to-head trials, and rank the safest intervention.”
The analysis included 18 trials comprising a total of 2,051 AKI events among 156,690 patients.
Results showed SGLT2 inhibitors were associated with a lower risk for AKI compared with placebo (OR = 0.76). Of this, the researchers wrote: “SGLT2 inhibitors showed a protective effect on the risk of AKI, whereas both DPP-4 inhibitors and GLP-1RAs had neutral effects.”
SGLT2 inhibitors were also associated with a lower risk for AKI than GLP-1RAs (OR = 0.79) and DPP-4 inhibitors (OR = 0.68).
Further findings indicated SGLT2 inhibitors had the highest probability of being the safest intervention at 84% (for comparison, GLP-1RAs and DPP-4 inhibitors had a 1% and 0% probability, respectively).
“SGLT2 inhibitors are the best choice for reducing AKI risk,” Zhao and colleagues concluded. “These findings enable health care clinicians to select the best glucose-lowering drug for patients with a high risk of AKI.”
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