| Objective To assess efficacy and safety of empagliflozin and other antidiabetic agents for type 2 diabetes(T2DM).Methods We searched Pubmed,Web of science,Up to date,Embase,Karger,OVID,Cochrane library,Scopus,EBSCO,Google,CBM,CNKI,Wanfang and Potentially relevant unpublished data were searched from clinicaltrials.gov,the Food and Drug Administration(FDA)Web site,American Diabetes Association,diabetes care,Chinese journal of diabetes,Chinese Journal of New Drugs and Clinical Remedies,Chinese journal of diabetes mellitus.Reference lists of eligible studies were hand-searched from relevant magazines.Randomised controlled trials(RCTs)of Empagliflozin compared with other antidiabetic drugs monotherapy or combination in T2 DM were selected,and two investigators assessed the quality of eligible studies by using the risk of bias tools.Meta-analysis of data was pooled by the RevMan 5.3 software and STATA 12 software.Result 7 randomized controlled trials involving 4135 patients with T2 DM were analyzed.?1 Compared with MET,10 mg EMPA was inferior to MET in HbA1 c [WMD 0.27%,95%CI(0.02,0.52),P=0.03];EMPA 25 mg was similar to MET [WMD 0.12%,95%CI(-0.13,0.37),P=0.34].(2)Compared with DPP-4 inhibitors,10 mg EMPA was no statistically significant difference in HbA1 c [WMD 0.00%,95%CI(-0.10,0.11),P=0.94],25 mg EMPA was superior to MET [WMD-0.11%,95%CI(-0.22,0.00),P=0.04].Compared with DPP-4 inhibitors as add-on MET,10 mg EMPA as add-on MET was no statistically significant difference in Hb A1c[WMD-0.10%,95%CI(-0.23,0.03),P=0.13],25 mg EMPA as add-on MET lead to greater reduction inHb A1 c [WMD-0.16%,95%CI(-0.30,-0.03),P=0.01].?3 When compared glimepiride as add-on to MET,25 mg EMPA as add-on to MET provided a significantly greater reduction in HbA1c[WMD-0.11%,95%CI(-0.19,-0.03),P=0.010].Compared with MET,both doses of EMPA were similar to MET in FPG [10 mg: WMD 0.05,95%CI(-0.50,0.60),P=0.86;25mg: WMD-0.07,95%CI(-0.62,0.48),P=0.80].Compared with DPP-4 inhibitors,both doses of EMPA significantly reduced FPG [10mg: WMD-0.81,95%CI(-1.01,-0.60),P<0.00001;25mg: WMD-0.99,95%CI(-1.2,-0.79),P<0.00001].Compared with DPP-4 inhibitors as add-on MET,both doses of EMPA as add-on MET provided a significantly greater reduction in FPG [10mg: WMD-0.40,95%CI(-0.68,-0.13),P=0.004;25mg: WMD-0.62,95%CI(-1.00,-0.24),P=0.002].When compared glimepiride as add-on to MET,25 mg EMPA as add-on to MET provided a significantly greater reduction in FPG[WMD-0.68,95%CI(-0.86,-0.50),P<0.00001].Compared with MET,both doses of EMPA provided a significantly greater reduction in body weight[10mg: WMD-1.01;95% CI(-1.73,-0.29),P=0.006;25mg:WMD-1.11;95%CI(-1.83,-0.39),P=0.002].Compared with DPP-4 inhibitor,both doses of EMPA had a favourable effect on body weight loss [10mg: WMD-2.38kg;95%CI(-2.74,-2.02),P<0.00001;25mg: WMD-2.63kg;95%CI(-3.00,-2.27),P<0.00001].Compared with DPP-4 inhibitor as add-on MET,both doses of EMPA as add-on provided a significantly greater reduction in body weight [10mg: WMD-2.02kg;95%CI(-2.60,-1.44),P<0.00001;25mg: WMD-2.52kg;95%CI(-3.41,-1.62),P<0.00001].When compared glimepiride as add-on to MET,25 mg EMPA as add-on to MET provided a significantly greater reduction in body weight[WMD-4.80 kg,95%CI(-5.12,-4.48),P<0.00001].In addition,EMPA monotherapy or as add-on to MET provided a significantly greater reduction in blood pressure.The risk of hypoglycaemia in EMPA were similar with DPP-4inhibitor,but was lower to glimepiride.Compared with control group,the risk of genital tract infections were higher in EMPA group.The risks of urinary tract infections were no statistically significant difference when compared EMPA group with control group.Conclusion Compared with DPP-4 inhibitors and glimepiride,Empagliflozin was well tolerated and greater reduction in glucose lowing,body weight and blood pressure.However,high-quality,large sample trials are still needed to confirm their long-term safety. |
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