Real-world data back SGLT2 inhibitor benefits even for people initially free of CVD
medwireNews: A real-world study shows a reduced risk for heart failure (HF) hospitalization, even in people without pre-existing cardiovascular disease (CVD), with use of sodium-glucose cotransporter (SGLT)2 inhibitors versus glucagon-like peptide (GLP)-1 receptor agonists.
The two medication classes resulted in broadly similar CVD outcomes, however, show the findings published in the Annals of Internal Medicine.
Elisabetta Patorno (Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA) and co-researchers note that no randomized trials exist or are planned comparing SGLT2 inhibitors and GLP-1 receptor agonists head to head.
“Thus, we believe these data represent the first comprehensive attempt to make such a comparison, albeit in an observational rather than experimental context,” they write.
Drawing on data from US commercial and Medicare insurance claims databases, the team found that although HF hospitalization was a rare event in people with type 2 diabetes who did not have pre-existing CVD, it was nevertheless significantly less frequent among the 50,102 SGLT2 inhibitor users than in an equal number of propensity score-matched users of a GLP-1 receptor agonist.
Specifically, the incidence rate of HF hospitalization per 1000 person–years was 1.32 versus 1.90, giving a significant 31% risk reduction.
This was similar to the significant 29% risk reduction seen for 181,803 SGLT2 inhibitor users who did have CVD versus an equal matched number of GLP-1 receptor agonist users, but the incidence rates, of 11.95 versus 16.92 per 1000 person–years, were much higher than in people without CVD and the absolute benefit of SGLT2 inhibition therefore greater.
Rates of CVD (myocardial infarction and stroke) were overall higher than HF hospitalization rates, but less affected by which medication class people were using.
There was a significant 10% risk reduction with SGLT2 inhibitors versus GLP-1 receptor agonists for people with pre-existing CVD, at rates per 1000 person–years of 21.29 versus 23.76.
The researchers stress, however, that “features related to the study, including potential unmeasured confounding, potential ascertainment bias, and the large sample size, merit cautious acceptance of this finding.”
There was no significant treatment-related difference in CVD risk among people without pre-existing disease, at rates of 7.16 and 6.78 per 1000 person–years among those taking SGLT2 inhibitors and GLP-1 receptor agonists, respectively.
For all-cause mortality, Patorno and team found no overall difference between the treatment groups, and a significant 12% risk reduction for people with pre-existing CVD taking an SGLT2 inhibitor versus a GLP-1 receptor agonist, at a reduction of 1.79 deaths per 1000 person–years.
They say: “Although our mortality data are limited and are available in reasonable numbers only from Medicare subscribers, they nonetheless suggest that large differences in effectiveness between the 2 therapies can be excluded with respect to all-cause mortality.”
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