medwireNews: Real-world data published in The BMJ confirm the cardioprotective benefits of sodium-glucose cotransporter (SGLT)2 inhibitor use, relative to dipeptidyl peptidase (DPP)-4 inhibitor use, in people with type 2 diabetes.
The register-based Scandinavian study, which included 20,983 new SGLT2 inhibitor users and 20,983 propensity score-matched new DPP-4 inhibitor users, found that SGLT2 inhibitor use was associated with a significant 34% lower risk for heart failure (hospitalization or death) relative to DPP-4 inhibitor use.
In line with findings of a previous meta-analysis reported by medwireNews, Björn Pasternak (Karolinska Institutet, Stockholm, Sweden) and co-authors say that their real-world data will “help inform patients, practitioners, and authorities regarding the cardiovascular effectiveness of SGLT2 inhibitors in routine clinical practice.”
The team also found that, during 1.4 years of follow-up, SGLT2 inhibitor use was associated with a significant 20% reduced risk for all-cause mortality compared with DPP-4 inhibitor use but was not associated with a significant reduction in the risk for major cardiovascular events (MACE; myocardial infarction, stroke, and cardiovascular death).
“A longer duration of follow-up might be required to detect differences in the major cardiovascular events outcome,” Pasternak et al remark.
During the follow-up period, MACE occurred at an incidence rate of 17.0 and 18.0 events per 1000 person–years in the SGLT2 and DPP-4 inhibitor groups, respectively, while the corresponding rates of heart failure were 4.7 and 7.1 events per 1000 person–years.
The researchers report that their findings were consistent among patients with and without a history of MACE or heart failure, and that additional analyses, conducted on an as-treated rather than intention-to-treat basis, strengthened the associations they observed.
Indeed, the risk for heart failure was a significant 45% lower with SGLT2 inhibitor use than with DPP-4 inhibitor use in the as-treated analysis, while that for all-cause mortality was 25% lower.
This secondary analysis also revealed a significant 16% lower risk for MACE with SLGT2 inhibitors versus DPP-4 inhibitors that was largely driven by a significant 33% reduction in the risk for cardiovascular death.
There was no difference between the SLGT2 and DPP-4 inhibitor groups in the rate of lower limb amputation, at 3.1 versus 2.6 events per 1000 person–years, but people using SGLT2 inhibitors had a significant 2.14-fold higher risk for diabetic ketoacidosis, with rates of 1.4 and 0.6 events per 1000 person–years, respectively.
Pasternak and co-investigators note that patients who initiated dapagliflozin accounted for 83% of the person–years of follow-up among the SGLT2 inhibitor users, and their results therefore “mainly apply to this specific drug.”
The researchers conclude: “Investigation of cardiovascular events associated with different individual SGLT2 inhibitors and their head-to-head effectiveness represent important topics for future studies.”
By Laura Cowen
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