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Dulaglutide provides CKD benefits for those with type 2 diabetes, macroalbuminuria
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SAN FRANCISCO — A 1.5 mg daily dose of dulaglutide may limit kidney function deterioration and the onset of end-stage renal disease for adults with type 2 diabetes and chronic kidney disease, particularly when macroalbuminuria is also present, according to findings presented at the American Diabetes Association Scientific Sessions.
“We’ve never had a drug that’s prevented progression to end-stage renal disease in advanced CKD,” Katherine R. Tuttle, MD, FASN, FACP, FNKF, professor of medicine at the Kidney Research Institute and the University of Washington in Seattle, told Endocrine Today. “We’ve shown that there’s therapy that can prevent one of the most feared complications in kidney disease, which is renal failure even in advanced stages. I know a lot of the emphasis [is] upstream, but I’m going to make the case that we need downstream treatments too — treating people with advanced CKD who have no options because most people aren’t going to get upstream treatment.”
In a post hoc analysis of the AWARD-7 trial, which compared renal outcomes of dulaglutide (Trulicity, Eli Lilly) vs. insulin glargine, Tuttle and colleagues divided participants by albuminuria status and compared how each treatment affected estimated glomerular filtration rate variance, particularly when lowered by at least 40%, as well as the occurrence of ESRD, which was determined by dialysis initiation or kidney transplantation, according to Tuttle.
Treatment with either 0.75 mg dulaglutide (n = 190; mean age, 64.7 years; 45% women), 1.5 mg dulaglutide (n = 192; mean age, 64.7 years; 46% women) or insulin glargine (n = 194; mean age, 64.3 years; 52% women) was randomly assigned to participants with type 2 diabetes and at least stage 3 CKD. Follow-up assessments occurred at 1 year of treatment.
ESRD or an eGFR reduction of at least 40% occurred in 5.2% of those taking 1.5 mg dulaglutide, 8.4% of those taking 0.75 mg dulaglutide and 10.8% of those taking insulin glargine. The difference was particularly noticeable among those with macroalbuminuria; 22.2% of participants taking insulin glargine lost at least 40% of eGFR or reached ESRD compared with rates of 16.7% and 7.1% among those taking 0.75 mg dulaglutide and 1.5 mg dulaglutide, respectively. Tuttle noted that there were far fewer occurrences of either endpoint in participants with microalbuminuria or normal urinary albumin to creatinine ratio compared with those with macroalbuminuria.
“There weren’t very many events in those other patients because within 1 year they had better preserved kidney function and they weren’t as likely to go into kidney failure,” Tuttle said, noting that these findings are merely hypothesis-generating at this point. “What we really need to do is a bigger, longer study because if you look at REWIND, it suggests it’s beneficial very early. I showed very late. The link in between the two is the middle.” – by Phil Neuffer
Reference:
Tuttle KR. Chronic kidney disease (CKD) outcomes with dulaglutide (DU) vs. insulin glargine (IG) in type 2 diabetes (T2D) and moderate-to-severe CKD by albuminuria status: AWARD-7. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco.
Disclosure: Tuttle reports she has served as a consultant for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Gilead Sciences and Goldfinch Bio and received research support from Eli Lilly.