SGLT2 inhibitors superior to GLP-1 receptor agonists for some CV outcomes
In a population-based cohort study, patients with diabetes taking an SGLT2 inhibitor had lower risk for hospitalization for HF compared with those taking a GLP-1 receptor agonist, researchers reported.
In addition, SGLT2 inhibitors were associated with slightly lower risk for MI or stroke compared with GLP-1 receptor agonists in patients with diabetes and CVD, but not in patients with diabetes but not CVD.
Elisabetta Patorno, MD, DrPH, associate professor of medicine at Harvard Medical School and Brigham and Women’s Hospital, and colleagues analyzed patients with diabetes from Medicare and two commercial datasets who were prescribed an SGLT2 inhibitor or a GLP-1 receptor agonist from April 2013 to December 2017.
The cohort included 52,901 propensity-score matched pairs of patients with diabetes and CVD and 133,139 propensity-score matched pairs of patients with diabetes but no CVD. Median follow-up was 7 months.
Among those with CVD, compared with patients taking GLP-1 receptor agonists, patients taking SGLT2 inhibitors had slightly reduced risk for MI or stroke (HR = 0.9; 95% CI, 0.82-0.9; risk difference, –2.47; 95% CI, –4.45 to –0.5), according to the researchers.
However, they wrote, in those without CVD, there was no difference between those taking SGLT2 inhibitors and those taking GLP-1 receptor agonists in risk for MI or stroke (HR = 1.07; 95% CI, 0.97-1.18; risk difference, 0.38; 95% CI, –0.3 to 1.07).
Patients taking SGLT2 inhibitors had lower risk for HF hospitalization than patients taking GLP-1 receptor agonists regardless of whether they had CVD (HR = 0.71; 95% CI, 0.64-0.79; risk difference, –4.97; 95% CI, –6.55 to –3.39) or not (HR = 0.69; 95% CI, 0.56-0.85; risk difference, –0.58; 95% CI, –0.91 to –0.25), Patorno and colleagues wrote.
“These real-world clinical data support the existing guidelines, which suggest that SGLT2
inhibitors and GLP-1 receptor agonists offer similar benefits in atherosclerotic CVD prevention to patients with type 2 diabetes and that SGLT2 inhibitors offer greater efficacy in hospitalized HF prevention,” the researchers wrote.
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