SUSTAIN 10 analysis supports additive benefits of GLP-1 receptor agonists, SGLT2 inhibitors
medwireNews: A post-hoc analysis of SUSTAIN 10 indicates that people with type 2 diabetes stand to gain from glucagon-like peptide (GLP)-1 receptor agonist use even if they are already using a sodium-glucose cotransporter (SGLT)2 inhibitor.
Researcher Matthew Capehorn (Rotherham Institute for Obesity, UK) noted that benefits are most likely also gained from the reverse scenario – adding an SGLT2 inhibitor to a GLP-1 receptor agonist – given the analysis demonstrated the effect of combined use.
He told delegates at the virtual 57th EASD Annual Meeting that SUSTAIN 10 was a particularly useful trial to address this issue because it tested two different GLP-1 receptor agonists (weekly semaglutide and daily liraglutide) and participants were stratified according to baseline medications.
Capehorn observed that “in clinical practice we’re already starting to use” GLP-1 receptor agonists and SGLT2 inhibitors in combination, but that “unfortunately, evidence for safety and efficacy using these two agents together is quite limited.”
The SUSTAIN 10 population yielded 73 people taking semaglutide 1.0 mg/week with a background SGLT2 inhibitor and 217 without, as well as 69 taking liraglutide 1.2 mg/day with a background SGLT2 inhibitor and 218 without. The vast majority were also taking metformin and between a third and a half were taking a sulfonylurea.
During 30 weeks of treatment, all four groups achieved significant reductions in their average glycated hemoglobin (HbA1c) level, regardless of whether or not they were taking an SGLT2 inhibitor at baseline.
For the semaglutide groups the average reductions were 1.6 and 1.8 percentage points with and without background SGLT2 inhibitor therapy, respectively, and the corresponding reductions for people taking liraglutide were 0.7 and 1.1 percentage points.
The same pattern was observed for bodyweight reduction, with average decreases of 5.3 and 5.9 kg for people taking semaglutide with and without background SGLT2 inhibitor therapy, respectively, and of 1.1 and 2.2 kg for those taking liraglutide.
“Therefore, patients in the clinic who are already receiving SGLT2 inhibitors may benefit from adding an additional GLP-1 receptor agonist to their treatment regime,” said Capehorn.
He noted “it perhaps isn’t that surprising” that people not taking an SGLT2 inhibitor tended to have larger benefits from the initiation of “a potent medication like a GLP-1 receptor agonist” than people who had already gained HbA1c and bodyweight benefit from SGLT2 inhibitor use prior to baseline.
Adverse events were as expected for the two medication classes, with rates being overall similar across the groups with the exception of those for infections and infestations, which were higher in people taking background SGLT2 inhibitor therapy.
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