Journal of diabetes and its complications · 2025
Dipeptidyl peptidase-4 inhibitors and diabetic retinopathy in type 2 diabetes: A network meta-analysis of randomized clinical trials.
СтатьяNetwork Meta-AnalysisОбзорНазвание и аннотация: Перевод пока не подготовлен
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Ortiz-Seller Amparo, Real José Tomás, Morcillo Esteban, Ortiz José Luis
Аннотация
AIMS: To update evidence on the relationship between dipeptidyl peptidase-4 (DPP-4) inhibitors and incident diabetic retinopathy (DR) in type 2 diabetes.
METHODS: We searched Embase, PubMed, Web of Science, and ClinicalTrials.gov (to July 2025) for randomized controlled trials (RCTs) and pooled odds ratios (ORs) with 95 % credible intervals (CrIs) using a Bayesian network meta-analysis. Network meta-regression assessed estimated effect modification; a model-based network meta-analysis (MBNMAdose) evaluated dose-response. Evidence certainty was appraised with Confidence in Network Meta-Analysis (CINeMA).
RESULTS: Forty-three trials (74,546 participants; 779 DR events) were analyzed. No DPP-4 inhibitor significantly changed the DR risk versus placebo (ORs ranged from 0.31 [omarigliptin] to 2.31 [saxagliptin]; all CrIs crossed 1.0). Rankings suggested omarigliptin as most favorable, alogliptin/linagliptin/sitagliptin intermediate, and saxagliptin/teneligliptin least favorable. Baseline DR incidence moderated treatment effects; other prespecified covariates were not significant. MBNMAdose showed no dose-response relationship for DR.
CONCLUSIONS: Current randomized evidence indicates class-level neutrality of DPP-4 inhibitors on DR incidence, with no dose-response signal. Choice among gliptins may therefore be guided primarily by glycemic efficacy, safety, and participant characteristics rather than retinal risk.
METHODS: We searched Embase, PubMed, Web of Science, and ClinicalTrials.gov (to July 2025) for randomized controlled trials (RCTs) and pooled odds ratios (ORs) with 95 % credible intervals (CrIs) using a Bayesian network meta-analysis. Network meta-regression assessed estimated effect modification; a model-based network meta-analysis (MBNMAdose) evaluated dose-response. Evidence certainty was appraised with Confidence in Network Meta-Analysis (CINeMA).
RESULTS: Forty-three trials (74,546 participants; 779 DR events) were analyzed. No DPP-4 inhibitor significantly changed the DR risk versus placebo (ORs ranged from 0.31 [omarigliptin] to 2.31 [saxagliptin]; all CrIs crossed 1.0). Rankings suggested omarigliptin as most favorable, alogliptin/linagliptin/sitagliptin intermediate, and saxagliptin/teneligliptin least favorable. Baseline DR incidence moderated treatment effects; other prespecified covariates were not significant. MBNMAdose showed no dose-response relationship for DR.
CONCLUSIONS: Current randomized evidence indicates class-level neutrality of DPP-4 inhibitors on DR incidence, with no dose-response signal. Choice among gliptins may therefore be guided primarily by glycemic efficacy, safety, and participant characteristics rather than retinal risk.