SGLT2 inhibitors may delay kidney complications better than other anti-diabetes agents
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Key takeaways:
- SGLT2 and GLP-1 agents were linked to lower risk of kidney-related outcomes for adults with type 2 diabetes and low cardiovascular risk.
- SGLT2 inhibitors were linked to better outcomes relative to GLP-1s.
In a real-world study, SGLT2 inhibitors and GLP-1 agents were more effective than dipeptidyl peptidase-4 inhibitors and sulfonylureas in reducing kidney complications for adults with type 2 diabetes and moderate cardiovascular risk.
In a retrospective observational study, researchers evaluated data from adults with type 2 diabetes and moderate cardiovascular disease risk. The analysis emulated an idealized target trial using claims data from OptumLabs Data Warehouse and included 364,714 adults. Among the study population, 78,843 were prescribed a dipeptidyl peptidase-4 inhibitor; 42,049 were prescribed a GLP-1 receptor agonist; 45,466 were prescribed an SGLT2 inhibitor and 198,356 were prescribed a sulfonylurea.
“Currently, agents with evidence of cardiorenal benefit (eg, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists) are not preferentially recommended over other glucose-lowering therapies in patients at lower (eg, moderate) CVD risk,” Joshua J. Neumiller, PharmD, CDCES, FADCES, FASCP, the Allen I. White Distinguished Professor in the department of pharmacotherapy in the College of Pharmacy and Pharmaceutical Sciences at Washington State University, wrote with colleagues. However, “in large cardiovascular outcome trials, agents from the SGLT2 inhibitor and GLP-1 receptor agonist classes demonstrated CVD benefit in addition to reporting benefits on variably defined exploratory secondary kidney disease outcomes inclusive of progressive decline in eGFR and/or new onset or worsening albuminuria.”
To assess the effectiveness of each treatment, researchers analyzed data on incident CKD stages 3 through 5, kidney failure or the need for kidney replacement therapy as the main composite outcomes.
Both SGLT2 inhibitors (HR = 0.71; 95% CI, 0.67-0.74) and GLP-1 receptor agonists (HR = 0.87; 95% CI, 0.83-0.92) were more effective than dipeptidyl peptidase-4 inhibitors for the main outcome. In addition, SGLT2 inhibitors (HR = 0.69; 95% CI, 0.66-0.73) and GLP-1 receptor agonists (HR = 0.86; 95% CI, 0.82-0.91) were associated with lower risks for the main outcome relative to sulfonylurea treatment.
Neumiller and colleagues found use of SGLT2 inhibitors (HR: 0.69; 95% CI, 0.66-0.73) and GLP-1 receptor agonists (HR = 0.86; 95% CI, 0.82-0.91) were associated with greater risk reductions of the primary outcomes relative to sulfonylurea.
Comparing SGLT2 inhibitors to GLP-1 receptor agonists, SGLT2 inhibitors were superior for the main composite outcome (HR = 0.81; 95% CI, 0.75-0.76).
Overall, SGLT2 inhibitors were associated with 29% (HR = 0.71; 95% CI, 0.67-0.74) and 28% (HR = 0.72; 95% CI, 0.70-0.75) lower risks for CKD stages 3 through 5, kidney failure or the need for kidney replacement therapy, while GLP-1 receptor agonists were associated with a 13% (HR = 0.87; 95% CI, 0.83-0.92) and 14% (HR = 0.86; 95% CI, 0.82-0.90) lower risk, respectively, than dipeptidyl peptidase-4 inhibitors.
“These findings provide important real-world evidence to support clinical decision-making for patients with type 2 diabetes with moderate CVD risk,” the researchers wrote.
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