First-line SGLT2 inhibitors lower risk for heart failure hospitalization vs. metformin

For patients with type 2 diabetes, first-line SGLT2 inhibitors might be better than metformin when it comes to their cardiovascular health, according to results of a population-based cohort study.

Since 2018, SGLT2 inhibitors have been endorsed as a second-line treatment for type 2 diabetes and have recently been recommended as a first-line treatment, HoJin Shin, BPharm, PhD, a postdoctoral research fellow at Brigham and Women’s Hospital, and colleagues wrote in Annals of Internal Medicine.

The researchers analyzed claims data from two large U.S. commercial and Medicare databases from April 2013 to March 2020, identifying patients without any use of antidiabetic medications before cohort entry.

In studying 8,613 patients who initiated first-line treatment with SGLT2 inhibitors and 17,226 patients who initiated metformin, Shin and colleagues found the treatments were associated with a similar risk for a composite outcome of myocardial infarction, hospitalization for stroke or all-cause mortality (HR = 0.96; 95% CI, 0.77-1.19) during a mean follow-up period of 12 months. However, SGLT2 inhibitors were linked to a lower risk for a composite outcome of hospitalization for heart failure (HHF) or all-cause mortality (HR = 0.8; 95% CI, 0.66-0.97) compared with metformin. This finding, according to the researchers, was driven by a lower risk for HHF (HR = 0.78; 95% CI, 0.63-0.97).

Patients initiating SGLT2 inhibitors also demonstrated a “numerically lower risk for MI” (HR = 0.7; 95% CI, 0.48-1), Shin and colleagues wrote. In addition, they had a higher risk for genital infections (HR = 2.19; 95% CI, 1.91-2.51), which the researchers said “may be less serious than other safety outcomes and can be appropriately managed.” Otherwise, the treatments appeared to have similar safety profiles.

“Although our findings may support the use of [SGLT2 inhibitors] as first-line [type 2 diabetes] treatment of cardiovascular outcomes, further research, that is, a randomized clinical trial, is warranted to establish more robust evidence,” the researchers wrote.