title: Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: A Bayesian meta-analysis of survival data.
abstract: To conduct a systematic review and meta-analysis to determine the risk of cardiovascular events and all-cause mortality associated with sulphonylureas (SUs) vs other glucose lowering drugs in patients with T2DM (T2DM).
  
  
  
  A systematic review of Medline, Embase, Cochrane and clinicaltrials.gov was conducted for studies comparing SUs with placebo or other antihyperglycaemic drugs in patients with T2DM. A cloglog model was used in the Bayesian framework to obtain comparative hazard ratios (HRs) for the different interventions. For the analysis of observational data, conventional fixed-effect pairwise meta-analyses were used.
  
  
  
  The systematic review identified 82 randomized controlled trials (RCTs) and 26 observational studies. Meta-analyses of RCT data showed an increased risk of all-cause mortality and cardiovascular-related mortality for SUs compared with all other treatments combined (HR 1.26, 95% confidence interval [CI] 1.10-1.44 and HR 1.46, 95% CI 1.21-1.77, respectively). The risk of myocardial infarction was significantly higher for SUs compared with dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter-2 inhibitors (HR 2.54, 95% CI 1.14-6.57 and HR 41.80, 95% CI 1.64-360.4, respectively). The risk of stroke was significantly higher for SUs than for DPP-4 inhibitors, glucagon-like peptide-1 agonists, thiazolidinediones and insulin.
  
  
  
  The present meta-analysis showed an association between SU therapy and a higher risk of major cardiovascular disease-related events compared with other glucose lowering drugs. Results of ongoing RCTs, which should be available in 2018, will provide definitive results on the risk of cardiovascular events and all-cause mortality associated with SUs vs other antihyperglycaemic drugs.
authors.affiliation: Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Bain
authors.affiliation: Precision Health Economics, Vancouver, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Druyts
authors.affiliation: Precision Health Economics, Vancouver, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
authors.forename: Chakrapani
authors.initials: C
authors.lastname: Balijepalli
authors.affiliation: MSD Ltd, Hoddesdon, UK.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Baxter
authors.affiliation: Global Epidemiology, Pharmatelligence, Cardiff, UK.|Institute of Population Medicine, Cardiff University, Cardiff, UK.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Currie
authors.affiliation: MSD Ltd, Hoddesdon, UK.
authors.forename: Romita
authors.initials: R
authors.lastname: Das
authors.affiliation: School of Medicine, University of Nottingham, Derby, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Donnelly
authors.affiliation: University of Leicester, Leicester, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
authors.affiliation: MSD Ltd, Hoddesdon, UK.
authors.forename: Haya
authors.initials: H
authors.lastname: Langerman
authors.affiliation: MSD Ltd, Hoddesdon, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Leigh
authors.affiliation: Precision Health Economics, Vancouver, Canada.
authors.forename: Gaye
authors.initials: G
authors.lastname: Siliman
authors.affiliation: Precision Health Economics, Vancouver, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorlund
authors.affiliation: Precision Health Economics, Vancouver, Canada.
authors.forename: Kabirraaj
authors.initials: K
authors.lastname: Toor
authors.affiliation: Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Jiten
authors.initials: J
authors.lastname: Vora
authors.affiliation: Precision Health Economics, Vancouver, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D001499:Bayes Theorem; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use; D052216:Glucagon-Like Peptide 1 / Q000819:agonists; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D016016:Proportional Hazards Models; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D020521:Stroke / Q000453:epidemiology; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*; D015996:Survival Rate; D045162:Thiazolidinediones / Q000627:therapeutic use
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D052216:Glucagon-Like Peptide 1
keywords: 
  T2DM
  ; cardiovascular disease; meta-analysis; sulphonylureas; systematic review