Please use this identifier to cite or link to this item: https://ir.swu.ac.th/jspui/handle/123456789/29359
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dc.contributor.authorSiriyotha S.
dc.contributor.authorLukkunaprasit T.
dc.contributor.authorAngkananard T.
dc.contributor.authorLooareesuwan P.
dc.contributor.authorMcKay G.J.
dc.contributor.authorAttia J.
dc.contributor.authorThakkinstian A.
dc.contributor.otherSrinakharinwirot University
dc.date.accessioned2023-11-15T02:08:21Z-
dc.date.available2023-11-15T02:08:21Z-
dc.date.issued2023
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85147897287&doi=10.3389%2ffendo.2023.1094221&partnerID=40&md5=db4f85310b975a8b3bf761a8458cf959
dc.identifier.urihttps://ir.swu.ac.th/jspui/handle/123456789/29359-
dc.description.abstractIntroduction: The cardiovascular benefits of multiple antihyperglycemic drugs as add-on therapies to metformin in the real-practice are unclear. This study aimed to directly compare major adverse cardiovascular events (CVE) associated with these multiple drugs. Methods: An emulation of a target trial was conducted using a retrospective-cohort data of type 2 diabetes mellitus (T2DM) prescribed with second-line drugs on top of metformin, including sodium-glucose cotransporter 2 inhibitors (SGLT2i), dipeptidyl peptidase-4 inhibitors (DPP4i), thiazolidinediones (TZD) and sulfonylureas (SUs). We applied inverse probability weighting and regression adjustment using intention-to-treat (ITT), per-protocol analysis (PPA) and modified ITT. Average treatment effects (ATE) were estimated using SUs as the reference. Results and Discussion: Among 25,498 patients with T2DM, 17,586 (69.0%), 3,261 (12.8%), 4,399 (17.3%), and 252 (1.0%) received SUs, TZD, DPP4i, and SGLT2i. Median follow-up time was 3.56 (1.36-7.00) years. CVE was identified in 963 patients. The ITT and modified ITT approaches showed similar results; the ATE (i.e., the difference of CVE risks) for SGLT2i, TZD, and DPP4i compared to SUs were -0.020(-0.040, -0.0002), -0.010(-0.017, -0.003), and -0.004(-0.010, 0.002), respectively, indicating 2% and 1% significant absolute risk reduction in CVE in SGLT2i and TZD compared to SUs. These corresponding effects were also significant in the PPA with ATEs of -0.045(-0.060, -0.031), -0.015(-0.026, -0.004), and -0.012(-0.020, -0.004). In addition, SGLT2i had 3.3% significant absolute risk reduction in CVE relative to DPP4i. Our study demonstrated benefits of SGLT2i and TZD in reducing CVE in T2DM patients compared to SUs when added to metformin. Copyright © 2023 Siriyotha, Lukkunaprasit, Angkananard, Looareesuwan, McKay, Attia and Thakkinstian.
dc.publisherFrontiers Media S.A.
dc.subjectantihyperglycemic drugs
dc.subjectcardiovascular events
dc.subjectdiabetes
dc.subjectmetformin
dc.subjectsecond-line
dc.titleClinical effectiveness of second-line antihyperglycemic drugs on major adverse cardiovascular events: An emulation of a target trial
dc.typeArticle
dc.rights.holderScopus
dc.identifier.bibliograpycitationFrontiers in Endocrinology. Vol 14, No. (2023)
dc.identifier.doi10.3389/fendo.2023.1094221
Appears in Collections:Scopus 2023

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