Older type 2 diabetes patients may derive greatest liraglutide benefits
medwireNews: The LEADER investigators report that treatment with the glucagon-like peptide (GLP)-1 receptor agonist liraglutide may be of particular benefit in the oldest patients with type 2 diabetes.
Their post-hoc analysis reported in the Annals of Internal Medicine suggests that patients aged 75 years or older had, relatively speaking, the largest reduction in cardiovascular risk if they were treated with liraglutide.
“Our analysis provides important information about a population in which clinical trial data are limited,” say Matthew Gilbert (The University of Vermont South Burlington, USA) and study co-authors.
The LEADER trial population (n=9340) included 418 patients aged at least 75 years who were randomly assigned to receive liraglutide and 418 who were given placebo. Cardiovascular events were most frequent in this age group; the primary composite endpoint of nonfatal myocardial infarction or stroke or of cardiovascular death occurred in 25.4% of the older placebo-treated patients compared with approximately 14% of patients younger than 75 years.
Nevertheless, being assigned to liraglutide reduced these oldest patients’ risk by a significant 44%, with cardiovascular events occurring in just 18.4% of those given the GLP-1 receptor agonist.
This relative risk reduction was larger than that observed in younger patients; liraglutide treatment reduced risk by a significant 23% in patients younger than 60 years and a nonsignificant 5% in those aged between 60 and less than 75 years.
The marked effect of liraglutide in the oldest age group was driven by a significant 45% reduction in nonfatal myocardial infarction, with rates of 12.2% versus 7.2% in patients given placebo. This age group also benefited from a significant 40% reduced risk for being hospitalized with heart failure (6.7 vs 10.0% for liraglutide vs placebo), with smaller, nonsignificant effects seen in younger patients.
However, the relative treatment effects in older patients were not statistically different from those in the younger age groups, and the researchers caution that there were a relatively small number of patients aged 75 years or older in their trial cohort.
Nevertheless, they say: “These results can help physicians make clinical decisions on optimal management of [type 2 diabetes] in elderly patients, a vulnerable population in which treatment options that evidently benefit important clinical end points are limited.”
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