Key result
SGLT-2 inhibitors, compared with DPP-4 inhibitors, were associated with lower risks of heart failure hospitalization in patients with T2D and no CKD (HR 0.76; 95% CI 0.70-0.82).
Why the study?
To determine the association with cardiovascular outcomes of SGLT-2 inhibitors compared with DPP-4 inhibitors in patients with type 2 diabetes and chronic kidney disease.
Do SGLT-2 inhibitors reduce cardiovascular outcomes compared to DPP-4 inhibitors in patients with type 2 diabetes and chronic kidney disease?
Cohort
Do SGLT-2 inhibitors reduce cardiovascular outcomes compared to DPP-4 inhibitors in patients with type 2 diabetes and chronic kidney disease?
Hazard Ratio: 0.76 (95% CI 0.7–0.82)
In real-world practice, incident use of SGLT-2 inhibitors compared to DPP-4 inhibitors is associated with reduced heart failure hospitalization in T2D patients with no or mild CKD, but this association was not significant in those with CKD stage 3a.
AIM: To determine the association with cardiovascular (CV) outcomes of sodium-glucose co-transporter-2 (SGLT-2) inhibitors compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). MATERIALS AND METHODS: We conducted a population-based cohort study of new users of SGLT-2 inhibitors and DPP-4 inhibitors with T2D and CKD using data from Optum Clinformatics DataMart. We assembled three cohorts: T2D/no CKD, T2D/CKD 1-2, and T2D/CKD 3a. The study outcomes were (a) time to first heart failure (HF) hospitalization and (b) time to a composite CV endpoint comprised of non-fatal myocardial infarction (MI) or stroke. After inverse probability of treatment weighting, we used proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: New users of SGLT-2 inhibitors versus DPP-4 inhibitors had lower risks of HF hospitalization in the T2D/no CKD (HR, 0.76; 95% CI, 0.70, 0.82) and T2D/CKD 1-2 (HR, 0.63; 95% CI, 0.48, 0.84) cohorts, but no significant association was present in the T2D/CKD 3a cohort. Compared with prescription of DPP-4 inhibitors, SGLT-2 inhibitors were associated with lower risks of non-fatal MI or stroke of 23% (HR, 0.77; 95% CI, 0.70, 0.85) in the T2D/no CKD cohort, but no significant associations were present in the T2D/CKD 1-2 and T2D/CKD 3a cohorts. CONCLUSIONS: Incident prescription of SGLT-2 inhibitors was associated with lower risks of HF hospitalization but not with non-fatal MI or stroke despite suggesting benefit, relative to prescription of DPP-4 inhibitor across different stages of CKD.
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Rhee et al. (2022) conducted a cohort in Type 2 diabetes and chronic kidney disease. SGLT-2 inhibitors vs. DPP-4 inhibitors was evaluated on Time to first heart failure (HF) hospitalization (HR 0.76, 95% CI 0.70, 0.82). SGLT-2 inhibitors, compared with DPP-4 inhibitors, were associated with lower risks of heart failure hospitalization in patients with T2D and no CKD (HR 0.76; 95% CI 0.70-0.82).
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