阿卡波糖对比二甲双胍治疗2型糖尿病疗效与安全性的系统评价及药物经济学分析  

Systematic Review of Efficacy and Safety and Pharmacoeconomics Analysis of Acarbose versus Metformin in the Treatment of Type 2 Diabetes

作　　者：杨璐[1] 孙路路[1] 王淑梅[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院药剂科,北京100038

出　　处：《中国药房》2015年第24期3371-3374,共4页China Pharmacy

基　　金：国家科技支撑计划课题(No.2013BAI06B04)

摘　　要：目的:系统评价阿卡波糖对比二甲双胍治疗2型糖尿病的有效性、安全性和经济性,以为临床治疗提供循证参考。方法:计算机检索Pub Med、Medline、中国期刊全文数据库、万方数据库、中文科技期刊数据库,收集阿卡波糖(试验组)对比二甲双胍(对照组)治疗2型糖尿病的随机对照试验(RCT),提取资料并进行质量评价后,采用Rev Man 5.2统计软件进行Meta分析,然后采用Tree Age Pro 2011.1.0.12.1软件运用决策树模型进行药物成本-效果分析。结果:共纳入8项RCT,合计418例患者。Meta分析结果显示,试验组患者餐后2 h血糖水平显著低于对照组[MD=-2.21,95%CI(-2.92,-1.51),P<0.001],而两组患者糖化血红蛋白水平[MD=0.02,95%CI(-0.38,0.34),P=0.91]、空腹血糖水平[MD=0.05,95%CI(0.91,1.01),P=0.92]和不良反应发生率[OR=1.84,95%CI(0.80,4.24),P=0.92]比较,差异无统计学意义。决策树分析结果显示,试验组与对照组的成本-效果比分别为847.15和272.53,两组的增量成本-效果比为13 776。结论:阿卡波糖降低2型糖尿病患者餐后2 h血糖疗效优于二甲双胍,但二甲双胍具有较高的经济学优势。受纳入研究方法学质量的限制,该结论有待大样本、高质量的RCT进一步验证。OBJECTIVE： To systematically review the efficacy, safety and economy of acarbose versus metformin in the treat ment of type 2 diabetes, and provide evidence-based reference for the clinical treatment. METHODS： Retrieved from PubMed, Medline, CJFD, Wanfang database, VIP database, randomized controlled trails （RCT） about acarbose （test group） versus metformin （control group） in the treatment of type 2 diabetes were collected. Meta-analysis was performed by using Rev Man 5.2 statistics software, and the decision tree model was used to do the cost-effectiveness analysis by using TreeAge Pro 2011.1.0.12.1 software. RESULTS： A total of 8 RCT, involving 418 patients. Results of Meta-analysis showed 2 h postprandial blood glucose （2 h PG） in test group [MD=-2.21, 95% CI（- 2.92,- 1.51）,P〈0.001] was lower than that of control group, there was no signifi- cant diffcrencc in the glycated hemoglobin levels[MD=0.02,95% CI （ - 0.38, 0.34）, P=0.91], fasting blood glucose level[MD= 0.05,95% CI（0.91,1.01） ,P=0.92] and incidence of adverse reactions [OR= 1.84,95% CI（0.80,4.24） ,P=0.92] between 2 groups. Results of decision tree analysis showed the cost-effectiveness ratio in test group and control group was 847.15 and 272.53,respectively; and incremental cost-effectiveness ratio was 13 776. CONCLUSIONS： Acarbose shows an obvious advantage on decreasing the 2 h PG of type 2 diabetes, however, pharmacoeconomics shows metformin has higher economic effects. Due to the limit of methodological quality, large-scale and high quality RCT are required for further validation of the conclusions.

关 键 词：阿卡波糖 二甲双胍 2型糖尿病 Meta分析 成本-效果分析 决策树 

分 类 号：R956[医药卫生—药学]