Key result
Once-weekly GLP-1 receptor agonists demonstrated cardiovascular safety compared with standard of care, with semaglutide and dulaglutide also showing cardiovascular and renal benefits.
Why the study?
Cardiovascular outcome trials of GLP-1 receptor agonists have been conducted, but healthcare professionals need a better understanding of these trials with a primary focus on once-weekly agents.
Do once-weekly GLP-1 receptor agonists improve cardiovascular and renal outcomes in people with type 2 diabetes compared with standard of care?
Do once-weekly GLP-1 receptor agonists improve cardiovascular and renal outcomes in people with type 2 diabetes compared with standard of care?
Once-weekly GLP-1 receptor agonists like semaglutide and dulaglutide provide cardiovascular and renal benefits beyond glycemic control for patients with type 2 diabetes at high cardiovascular risk.
May inform HCP counseling on CVOTs for once-weekly GLP-1 RAs in T2D; leaves open need for head-to-head trials.
WHAT IS KNOWN AND OBJECTIVE: People with type 2 diabetes (T2D) are at increased risk of cardiovascular disease (CVD), which in turn is associated with increased morbidity and mortality. The impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on cardiovascular (CV) outcomes has been investigated in CV outcomes trials (CVOTs). This review aims to help pharmacists and other healthcare professionals (HCPs) gain a better understanding of such CVOTs in T2D with a primary focus on the once-weekly (QW) GLP-1 RAs. METHODS: This narrative review mainly focuses on the evaluation of the similarities and differences in the design and results of CVOTs involving currently approved and marketed QW GLP-1 RAs-semaglutide subcutaneous, exenatide extended-release (ER) and dulaglutide. Results from CVOTs of dipeptidyl peptidase-4 inhibitors (DPP4is) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) are also included. RESULTS AND DISCUSSION: Three CVOTs of QW GLP-1 RAs were identified for inclusion in this review: SUSTAIN 6 (semaglutide), EXSCEL (exenatide ER) and REWIND (dulaglutide), all of which varied in terms of trial design, patient demographics and other baseline characteristics. Results from these CVOTs demonstrated the CV safety of QW GLP-1 RAs compared with standard of care. Additionally, CV and renal benefits were demonstrated for semaglutide and dulaglutide, but not for exenatide ER. The CV safety of four DPP4is and three SGLT2is was demonstrated. None of the DPP4is had a CV or renal benefit, whereas all three SGLT2is were associated with CV and renal benefits. WHAT IS NEW AND CONCLUSION: This article provides an overview of the results from QW GLP-1 RA CVOTs, including the recently published results for dulaglutide, and places them within the broader T2D treatment landscape to help HCPs make informed decisions in daily practice. The QW GLP-1 RAs with benefits reaching beyond glycaemic control can provide a comprehensive treatment option for people with T2D at high risk of CVD, with CVD or chronic kidney disease.
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Jennifer D. Goldman (2020) conducted a review in Type 2 diabetes. Once-weekly GLP-1 receptor agonists vs. Standard of care was evaluated on Cardiovascular safety and outcomes. Once-weekly GLP-1 receptor agonists demonstrated cardiovascular safety compared with standard of care, with semaglutide and dulaglutide also showing cardiovascular and renal benefits.
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