Comparative effects of SGLT2 inhibitors on Erythropoiesis: A systematic review and network meta-analysis
Abstract
Background and aims: Sodium glucose cotransporter-2 inhibitors (SGLT2is) may influence erythropoiesis, but intra-class differences and evidence certainty remain unclear. We evaluated the comparative effects of individual drugs on hematological parameters.
Methods: We searched electronic databases for randomized controlled trials comparing any SGLT2i with placebo, standard of care, or another SGLT2i. Outcomes included hemoglobin, hematocrit, red blood cell (RBC) count, erythropoietin, and anemia risk. Pooled estimates were calculated using standardized mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CI). Certainty of evidence was assessed.
Results: One hundred thirty-six studies (102,882 participants) were included. As a class, SGLT2is significantly increased post-intervention hemoglobin (SMD 0.42 [95% CI 0.33, 0.51]), change-from-baseline hemoglobin (SMD 0.87 [0.65, 1.10]), post-intervention hematocrit (SMD 0.53 [0.44, 0.62]), change-from-baseline hematocrit (SMD 0.91 [0.72, 1.10]), post-intervention RBC count (SMD 0.56 [0.37, 0.75]), change-from-baseline RBC count (SMD 0.94 [0.48, 1.39]), and post-intervention erythropoietin (SMD 0.26 [0.01, 0.52]), but did not reduce anemia risk (OR 0.93 [0.76, 1.14]). Among individual drugs, ertugliflozin showed the largest post-intervention hemoglobin increase, and canagliflozin showed the largest change-from-baseline hemoglobin increase. Evidence certainty was low to very low.
Conclusions: SGLT2is consistently…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 102,882 participants or records.
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