SGLT2 and dual SGLT1/2 inhibitors reduce cardiovascular death or heart failure hospitalization risk in type 2 diabetes patients

We conducted a systematic review and network meta-analysis to examine the overall and comparative cardiovascular outcomes of bexagliflozin, ertugliflozin, and sotagliflozin in type 2 diabetes patients. We included phase 3 or higher randomized controlled trials sourced from four databases: ClinicalTrials.gov, PubMed, Cochrane CENTRAL and Embase. A random-effects model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The primary endpoint was a composite of cardiovascular death or hospitalization for heart failure. The secondary endpoints were cardiovascular death, hospitalization for heart failure and all-cause mortality. Compared with placebo, bexagliflozin, ertugliflozin and sotagliflozin reduced composite cardiovascular death or hospitalization for heart failure (OR, 0.66 [95% CI 0.48-0.89]), hospitalization for heart failure (OR, 0.62 [0.55-0.70]) and acute coronary syndrome (OR, 0.35 [0.16-0.77]). No significant differences were observed among the three drugs for primary and secondary outcomes, although bexagliflozin (OR, 0.39 [0.16-0.94]) and sotagliflozin (OR, 0.41 [0.23-0.72]) had lower risks of myocardial infarction than did ertugliflozin. In conclusion, bexagliflozin, ertugliflozin, and sotagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure. Bexagliflozin and sotagliflozin may offer additional benefits in preventing the risk of myocardial infarction.