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Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: a Bayesian meta-analysis of survival data

Bain, Steve; Druyts, Eric; Balijepalli, Chakrapani; Baxter, Carl A.; Currie, Craig J.; Das, Romita; Donnelly, Richard; Khunti, Kamlesh; Langerman, Haya; Leigh, Paul; Siliman, Gaye; Thorlund, Kristian; Toor, Kabirraaj; Vora, Jiten; Mills, Edward J.

Authors

Steve Bain

Eric Druyts

Chakrapani Balijepalli

Carl A. Baxter

Craig J. Currie

Romita Das

Richard Donnelly

Kamlesh Khunti

Haya Langerman

Paul Leigh

Gaye Siliman

Kristian Thorlund

Kabirraaj Toor

Jiten Vora

Edward J. Mills



Abstract

Aim: To conduct a systematic review and meta-analysis to determine the risk of cardiovascular events and all-cause mortality associated with sulphonylureas (SUs) vs other glucose lowering drugs in patients with T2DM (T2DM.
Materials and methods: A systematic review of Medline, Embase, Cochrane and clinicaltrials.gov was conducted for studies comparing SUs with placebo or other antihyperglycaemic drugs in patients with T2DM. A cloglog model was used in the Bayesian framework to obtain comparative hazard ratios (HRs) for the different interventions. For the analysis of observational data, conventional fixed-effect pairwise meta-analyses were used.
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 SUs compared with all other treatments combined (HR 1.26, 95% confidence interval [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 SUs compared with dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter-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 SUs than for DPP-4 inhibitors, glucagon-like peptide-1 agonists, thiazolidinediones and insulin.
Conclusions: The present meta-analysis showed an association between SU therapy and a higher risk of major cardiovascular disease-related events compared with other glucose lowering 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 SUs vs other antihyperglycaemic drugs.

Journal Article Type Article
Publication Date Feb 27, 2017
Journal Diabetes, Obesity and Metabolism
Print ISSN 1462-8902
Electronic ISSN 1462-8902
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 19
Issue 3
APA6 Citation Bain, S., Druyts, E., Balijepalli, C., Baxter, C. A., Currie, C. J., Das, R., …Mills, E. J. (2017). Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: a Bayesian meta-analysis of survival data. Diabetes, Obesity and Metabolism, 19(3), doi:10.1111/dom.12821
DOI https://doi.org/10.1111/dom.12821
Keywords cardiovascular disease, meta-analysis, sulphonylureas, systematic review, T2DM
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/dom.12821/abstract
Related Public URLs https://cronfa.swan.ac.uk/Record/cronfa31167
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information This is the peer reviewed version of the following article: Bain, Steve and Druyts, Eric and Balijepalli, Chakrapani and Baxter, Carl A. and Currie, Craig J. and Das, Romita and Donnelly, Richard and Khunti, Kamlesh and Langerman, Haya and Leigh, Paul and Siliman, Gaye and Thorlund, Kristian and Toor, Kabirraaj and Vora, Jiten and Mills, Edward J. (2017) Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: a Bayesian meta-analysis of survival data. Diabetes, Obesity and Metabolism, 19 (3). pp. 329-335. ISSN 1462-8902 , which has been published in final form at http://onlinelibrary.wi...111/dom.12821/abstract. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

The Related URL is for the version deposited in Swansea University's repository. MJB 27.03.18.

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DOM-16-0335-OP.R2-Final Accepted version.pdf (620 Kb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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