{"id":"ccab5614f5ad","type":"article","url":"https://hartvaat.nl/2018/04/17/sglt2-remmers-glp-1-agonisten-en-dpp-4-remmers-vergelijkende-cardiovasculaire-me/","title":"SGLT2-remmers, GLP-1-agonisten en DPP-4-remmers: vergelijkende cardiovasculaire meta-analyse","title_en":"Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine","cardio-renaal-metabool","cardiorenal-behandelstrategie","cetp-remmers","diabetes-en-hart","diabetes-type-2","empagliflozine","ezetimibe","fidelity","figaro-dkd","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","microbioom","obesitas","obicetrapib","orforglipron","semaglutide","sglt2-remmers","tirzepatide"],"journal":"JAMA","doi":"10.1001/jama.2018.3024","source_url":"https://doi.org/10.1001/jama.2018.3024","authors":["Sean L Zheng","Alistair J Roddick","Rochan Aghar-Jaffar","Matthew J Shun-Shin","Darrel Francis","Nick Oliver","Karim Meeran"],"significance":9,"published":"2018-04-17","source_date":"2018-04-17","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This JAMA comparative meta-analysis showed that SGLT2 inhibitors and GLP-1 receptor agonists both reduce cardiovascular death, MI, and stroke compared with DPP-4 inhibitors in patients with type 2 diabetes. The analysis distinguished the distinct cardiovascular benefit profiles of each drug class and established their clinical superiority.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA vergelijkende meta-analyse van drie glucoseverlagende klassen op cardiovasculaire uitkomsten. SGLT2-remmers en GLP-1-agonisten superieur aan DPP-4-remmers voor CV-preventie.","abstract_original":"IMPORTANCE: The comparative clinical efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors for treatment of type 2 diabetes is unknown. OBJECTIVE: To compare the efficacies of SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors on mortality and cardiovascular end points using network meta-analysis. DATA SOURCES: MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, and published meta-analyses from inception through October 11, 2017. STUDY SELECTION: Randomized clinical trials enrolling participants with type 2 diabetes and a follow-up of at least 12 weeks were included, for which SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors were compared with either each other or placebo or no treatment. DATA EXTRACTION AND SYNTHESIS: Data were screened by 1 investigator and extracted in duplicate by 2 investigators. A Bayesian hierarchical network meta-analysis was performed. MAIN OUTCOMES AND MEASURES: The primary outcome: all-cause mortality; secondary outcomes: cardiovascular (CV) mortality, heart failure (HF) events, myocardial infarction (MI), unstable angina, and stroke; safety end points: adverse events and hypoglycemia. RESULTS: This network meta-analysis of 236 trials randomizing 176 310 participants found SGLT-2 inhibitors (absolute risk difference [RD], -1.0%; hazard ratio [HR], 0.80 [95% credible interval {CrI}, 0.71 to 0.89]) and GLP-1 agonists (absolute RD, -0.6%; HR, 0.88 [95% CrI, 0.81 to 0.94]) were associated with significantly lower all-cause mortality than the control groups. SGLT-2 inhibitors (absolute RD, -0.9%; HR, 0.78 [95% CrI, 0.68 to 0.90]) and GLP-1 agonists (absolute RD, -0.5%; HR, 0.86 [95% CrI, 0.77 to 0.96]) were associated with lower mortality than were DPP-4 inhibitors. DPP-4 inhibitors were not significantly associated with lower all-cause mortality (absolute RD, 0.1%; HR, 1.02 [95% CrI, 0.94 to 1.11]) than were the control groups. SGLT-2 inhibitors (absolute RD, -0.8%; HR, 0.79 [95% CrI, 0.69 to 0.91]) and GLP-1 agonists (absolute RD, -0.5%; HR, 0.85 [95% CrI, 0.77 to 0.94]) were significantly associated with lower CV mortality than were the control groups. SGLT-2 inhibitors were significantly associated with lower rates of HF events (absolute RD, -1.1%; HR, 0.62 [95% CrI, 0.54 to 0.72]) and MI (absolute RD, -0.6%; HR, 0.86 [95% CrI, 0.77 to 0.97]) than were the control groups. GLP-1 agonists were associated with a higher risk of adverse events leading to trial withdrawal than were SGLT-2 inhibitors (absolute RD, 5.8%; HR, 1.80 [95% CrI, 1.44 to 2.25]) and DPP-4 inhibitors (absolute RD, 3.1%; HR, 1.93 [95% CrI, 1.59 to 2.35]). CONCLUSIONS AND RELEVANCE: In this network meta-analysis, the use of SGLT-2 inhibitors or GLP-1 agonists was associated with lower mortality than DPP-4 inhibitors or placebo or no treatment. Use of DPP-4 inhibitors was not associated with lower mortality than placebo or no treatment."}