GLP-1 receptor agonists significantly reduced the risk of MACE-3 (HR 0.91) and non-fatal myocardial infarction (HR 0.77) compared to SGLT-2 inhibitors in patients with type 2 diabetes.
Cohort (n=41,524)
Does GLP-1 RA initiation reduce cardiovascular events compared to SGLT-2i initiation in patients aged 50 years and older with type 2 diabetes?
In a real-world cohort of patients with type 2 diabetes, initiation of GLP-1 RAs was associated with a lower risk of MACE and myocardial infarction compared to SGLT-2 inhibitors, particularly in those without established cardiovascular disease.
Hazard Ratio: 0.91 (95% CI 0.84–0.98)
BACKGROUND: GLP-1 receptor agonists (GLP-1 RA) and SGLT-2 inhibitors (SGLT-2i) have shown to reduce the risk of major adverse cardiovascular events (MACE), death and worsening nephropathy when added to standard of care. However, these two dug classes differ in efficacy and safety. We compared the effectiveness and safety profile of GLP-1 RA and SGLT-2i in a large and unselected cohort of patients with type 2 diabetes resident in Lombardy from 2015 to 2020. METHODS: Using linkable administrative health databases, we included patients aged 50 years and older initiating GLP-1 RA or SGLT-2i. Clinical events were: death, hospital admission for myocardial infarction (MI), stroke, heart failure (HF), and renal disease as individual and composite outcomes (MACE-3: all cause-death, non-fatal MI, non-fatal stroke; MACE-4: MACE-3 plus unstable angina). Outcomes were evaluated separately in subjects with and without previous cardiovascular (CV) diseases. Treatments were compared using Cox proportional hazards regression model after Propensity Score Matching (PSM) in both intention-to-treat (ITT) and per protocol (PP) analyses. Serious adverse events were also evaluated. RESULTS: The analysis comprised 20,762 patients per cohort. The ITT analysis showed a significant risk reduction for non-fatal MI (HR 0.77; CI 95% 0.66-0.90), MACE-3 (HR 0.91; CI 95% 0.84-0.98), and MACE-4 (HR 0.92; CI 95% 0.86-0.99) in GLP-1RA compared with SGLT-2i users, while no difference was reported in the incidence of HF hospitalization and stroke between the two cohorts. Similar benefits were found in the subgroup of patients without previous CV diseases only. PP analysis largely confirmed the main results. The incidence of serious adverse events was low in both cohorts (< 1%). CONCLUSIONS: GLP-1RA showed to be equally safe and more effective than SGLT-2i in reducing the risk of MACE-3, MACE-4 and MI. This study adds to the growing body of real-world evidence addressing the specific clinical properties of GLP-1RA and SGLT-2i in everyday practice to tailor treatment to the individual patient.
Baviera et al. (Wed,) conducted a cohort in Type 2 diabetes (n=41,524). GLP-1 receptor agonists vs. SGLT-2 inhibitors was evaluated on MACE-3 (all-cause death, non-fatal myocardial infarction, non-fatal stroke) (HR 0.91, 95% CI 0.84-0.98). GLP-1 receptor agonists significantly reduced the risk of MACE-3 (HR 0.91) and non-fatal myocardial infarction (HR 0.77) compared to SGLT-2 inhibitors in patients with type 2 diabetes.