Comparative effectiveness of OW GLP-1 RAs and other glucose-lowering therapies among Medicare beneficiaries with T2D and ASCVD

To compare the incidence rates for cardiovascular (CV) outcomes and healthcare resource utilization (HCRU) and costs among patients treated with once-weekly (OW) glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared with other non-insulin glucose lowering therapies (ONIGLTs). This was an observational cohort study using Medicare fee-for-service claims data (2006-2022). Medicare beneficiaries with T2D and ASCVD treated with OW GLP-1 RAs or ONIGLTs were matched using propensity score matching. Among the total 398,470 Medicare beneficiaries, OW GLP-1 RAs were associated with reduced risk of CV events (hazard ratios [HRs] range: 0.72 to 0.88, P < 0.05 for all) compared with ONIGLTs, in addition to lower HCRU and costs including ASCVD-related total medical visits (incidence rate ratio [95 % CI]: 0.877 [0.839-0.917]; P < 0.001) and total medical costs (mean cost ratio [95 %CI]: 0.882 [0.585-0.907]; P < 0.001). Among OW GLP-1 RAs, semaglutide had the lowest risk of all CV outcomes when compared with SGLT2is (HRs range: 0.80 to 0.85, P < 0.05 for all) and DPP-4is (HRs range: 0.58 to 0.73; P < 0.001 for all). The study findings corroborate current guideline recommendations for GLP-1 RAs in people with T2D and ASCVD, and extend findings to lower HCRU and costs in a real-world setting, most notably for semaglutide.