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Selection of RCTs

(Seng Chan You) #21

I’m working for the study comparing febuxostat and allopurinol (git). I’ll complete the protocol at Shanghai Hackathon in May.

By the way,
Today, meta-analysis, ‘Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes’ is published in JAMA. The authors concluded that SGLT-2 inhibitor and GLP-1 agonist has better survival benefit than DPP4 inhibitor.

In the observational research, CVD-REAL, CVD-REAL-Nordic, similar conclusion was drawn. But the HR for survival was 0.4~0.5. It doesn’t make sense for me that SGLT-2 is twice as good as DPP4 inhibitor.

I do know that the JAMA paper is meta-analysis paper, not an RCT. But it would be worth replicating the study comparing DPP-IV and SGLT-2 inhibitor for evaluating our method. Especially, focused on the size of the effect.

(Seng Chan You) #22

Another potential candidate for replication:
Effect of Aclidinium Bromide on Major Cardiovascular Events and Exacerbations in High-Risk Patients With Chronic Obstructive Pulmonary Disease
Published in JAMA, 2019.

Several meta-analyses and epidemiological studies indicated that short-acting and long-acting muscarinic antagonists (SAMAs and LAMAs) may increase the risk of cardiovascular event in patients with COPD and CVD risk factors.
ASCENT-COPD trial demonstrated that LAMA does not increase cardiovascular risk in patients with moderate or severe COPD.

I wonder OHDSI can come to a similar conclusion, too.
And I wonder this conclusion can be applied to those without CVD risk factors.