Abstract
Background: Concerns exist that mortality benefit might vary across different drugs (canagliflozin, empagliflozin, dapagliflozin) belonging to sodium-glucose cotransporter-2 (SGLT2) inhibitors. Methods: Twenty-two randomized controlled trials (n=59,018) having at least 500 participants and follow-up ≥1 year were selected from MEDLINE and EMBASE databases through October 2019. Meta-analysis was performed using fixed effect model (for I 2 < 25% {25 out of 100}) or random effects model. Results: SGLT2 inhibitors decreased risk of all-cause mortality (Hazard Ratio (HR) 0.85, [95% {95 out of 100} confidence interval, 0.79-0.91]). This benefit was consistent for canagliflozin (HR, 0.86, [0.76-0.97]), empagliflozin (HR, 0.70, [0.79-0.91]) and dapagliflozin (HR, 0.90, [0.82-0.99]) (P-interaction = 0.06). SGLT2 inhibitors reduced the risk of cardiovascular mortality (HR, 0.82 [0.74-0.90]), myocardial infarction (MI) (HR, 0.88 [0.80-0.97]), major adverse cardiovascular events (HR, 0.84 [0.78-0.91]), and heart failure hospitalizations (HR, 0.68 [0.62-0.75]). Conclusion: Canagliflozin, empagliflozin, dapagliflozin were associated with significant reduction in all-cause mortality. SGLT2 inhibitor was also associated with cardiovascular benefits in type 2 diabetes mellitus.
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