Key result
In patients with type 2 diabetes, evogliptin added to metformin reduced the risk of cardiovascular events compared to non-DPP4i dual therapy (HR 0.71; 95% CI 0.62-0.82).
Why the study?
The cardiovascular risk associated with commonly used dual and triple therapies of evogliptin in routine clinical practice was unknown.
Does evogliptin added to metformin or metformin+sulfonylurea reduce cardiovascular events in patients with type 2 diabetes?
Cohort
Yes
Does evogliptin added to metformin or metformin+sulfonylurea reduce cardiovascular events in patients with type 2 diabetes?
Hazard Ratio: 0.71 (95% CI 0.62–0.82)
Evogliptin added to metformin or metformin+sulfonylurea is associated with a reduced risk of cardiovascular events in patients with type 2 diabetes compared to non-DPP4i therapies.
Supports evogliptin add-on in T2D; observational data leave open need for RCT confirmation.
OBJECTIVE: To investigate the risk of cardiovascular events associated with commonly used dual and triple therapies of evogliptin, a recently introduced dipeptidyl peptidase-4 inhibitor (DPP4i), for managing type 2 diabetes in routine clinical practice. DESIGN: A retrospective cohort study. SETTING: Korean Health Insurance Review and Assessment database. PARTICIPANTS: Patients who initiated metformin-based dual therapy and metformin+sulfonylurea-based triple therapy in South Korea from 2014 to 2018. INTERVENTIONS: Initiation of combination therapy with evogliptin. PRIMARY AND SECONDARY OUTCOME MEASURES: Hazards of cardiovascular events, a composite endpoint of myocardial infarction, heart failure and cerebrovascular events, and its individual components. Cox proportional hazards model with propensity score-based inverse probability of treatment weighting were used to estimate HRs and 95% CIs. RESULTS: From the dual and triple therapy cohorts, 5830 metformin+evogliptin users and 2198 metformin+sulfonylurea+evogliptin users were identified, respectively. Metformin+evogliptin users, as compared with metformin+non-DPP4i, had a 29% reduced risk of cardiovascular events (HR 0.71, 95% CI 0.62 to 0.82); HRs for individual outcomes were cerebrovascular events (0.71, 95% CI 0.53 to 0.95), heart failure (0.70, 95% CI 0.59 to 0.82), myocardial infarction (0.89, 95% CI 0.60 to 1.31). Metformin+sulfonylurea+evogliptin users, compared with metformin+sulfonylurea+non-DPP4i, had a 24% reduced risk of cardiovascular events (0.76, 95% CI 0.59 to 0.97); HRs for individual outcomes were myocardial infarction (0.57, 95% CI 0.27 to 1.19), heart failure (0.74, 95% CI 0.55 to 1.01), cerebrovascular events (0.96, 95% CI 0.61 to 1.51). CONCLUSIONS: These findings suggest that dual or triple therapies of evogliptin for the management of type 2 diabetes in routine clinical practice present no cardiovascular harms, but could alternatively offer cardiovascular benefits in this patient population.
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Park et al. (2024) conducted a cohort in type 2 diabetes. Evogliptin vs. non-DPP4i was evaluated on Composite endpoint of myocardial infarction, heart failure and cerebrovascular events (HR 0.71, 95% CI 0.62 to 0.82). In patients with type 2 diabetes, evogliptin added to metformin reduced the risk of cardiovascular events compared to non-DPP4i dual therapy (HR 0.71; 95% CI 0.62-0.82).
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