GLP-1 receptor agonist therapy for diabetes associated with fewer asthma exacerbations

Adults with asthma and type 2 diabetes had lower counts of asthma exacerbations and symptoms after initiating treatment with a glucagon-like peptide-1 receptor agonist compared with other drugs for diabetes treatment intensification.

“In preclinical models ... GLP-1 receptor agonists have been shown to reduce allergic airway inflammation and viral-induced airway inflammation,” Katherine N. Cahill, MD, medical director of clinical asthma research in the division of allergy, pulmonary and critical care medicine at Vanderbilt University Medical Center, told Healio. “To translate these findings into human disease, we took advantage of the widespread use of GLP-1 receptor agonists for the treatment of type 2 diabetes and available clinical information in electronic health record data.”

Researchers conducted a retrospective cohort study using electronic health records to identify 5,940 adults with asthma and type 2 diabetes who were newly prescribed GLP-1 receptor agonists or comparator drugs from January 2000 to March 2018.

The primary outcome was number of asthma exacerbations. The secondary outcome was health care encounters for asthma symptoms.

In the cohort, 448 patients (mean age, 54 years; 72.1% women) initiated GLP-1 receptor agonists, 112 (mean age, 60 years; 58.9% women) sodium-glucose cotransporter 2 (SGLT2) inhibitors, 435 (mean age, 63.5 years; 65.7% women) dipeptidyl-peptidase IV (DPP-IV) inhibitors, 2,253 (mean age, 59.5 years; 61.6% women) sulfonylureas and 2,692 (mean age, 58.4 years; 65% women) basal insulin.

At 6 months, those who initiated GLP-1 receptor agonists had lower asthma exacerbation counts compared with those who initiated SGLT2 inhibitors (incidence rate ratio [IRR] = 2.98; 95% CI, 1.3-6.8), DPP-IV inhibitors (IRR = 2.45; 95% CI, 1.54-3.89), sulfonylureas (IRR = 1.83; 95% CI, 1.2-2.77) and basal insulin (IRR = 2.58; 95% CI, 1.72-3.88).

Researchers also observed lower health care encounters for asthma symptoms among those who initiated GLP-1 receptor agonists.

The findings remained significant after the researchers accounted for changes in glycemic control and weight loss, according to Cahill.

“Our findings support the preclinical data showing GLP-1 receptor agonists reduce lung inflammation in models of allergic and viral airway inflammation,” Cahill told Healio.

Taken together, the data from this study “support that the GLP-1 pathway may act directly in the airway to regulate lung function and/or inflammation in asthma,” Cahill said.

The researchers said further research is needed to validate these findings.

“Prospective studies in patients with asthma, with and without comorbid type 2 diabetes, are required to confirm the clinical benefits and mechanisms of GLP-1 receptor agonists,” Cahill said.

Cahill and colleagues plan to initiate such studies in the coming year.

For more information:

Katherine N. Cahill, MD, can be reached at katherine.cahill@vumc.org.