Mortality risk among sulfonylureas: a systematic review and network meta-analysis

We examined differences in cardiovascular event risk among sulfonylureas with random effects models for direct pairwise comparisons and network meta-analyses to incorporate direct and indirect data. Findings 14 970 (9%) of 167 327 patients in 18 studies died: 841 (4%) of 19 334 gliclazide users, 5482 (11%) of 49 389 glimepiride users, 2106 (15%) of 14 464 glipizide users, 5296 (7%) of 77 169 glibenclamide users, 1066 (17%) of 6187 tolbutamide users, and 179 (23%) of 784 chlorpropamide users. Inconsistency was low for the network meta-analysis of all-cause mortality, and the relative risk of death compared with glibenclamide was 0·65 (95% credible interval 0·53–0·79) for gliclazide, 0·83 (0·68–1·00) for glimepiride, 0·98 (0·80–1·19) for glipizide, 1·13 (0·90–1·42) for tolbutamide, and 1·34 (0·98–1·86) for chlorpropamide. Similar associations were noted for cardiovascular-related mortality: the relative risk compared with glibenclamide was 0·60 (95% credible interval 0·45–0·84) for gliclazide, 0·79 (0·57–1·11) for glimepiride, 1·01 (0·72–1·43) for glipizide, 1·11 (0·79–1·55) for tolbutamide, and 1·45 (0·88–2·44) for chlorpropamide. Interpretation Gliclazide and glimepiride were associated with a lower risk of all-cause and cardiovascular-related mortality compared with glibenclamide. Clinicians should consider possible differences in risk of mortality when selecting a sulfonylurea. Funding None.
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research