Meta-analysis confirms SGLT2 inhibitor heart failure, kidney disease benefits
medwireNews: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have a greater effect than glucagon-like peptide (GLP)-1 receptor agonists on reducing hospitalization for heart failure and kidney disease progression in patients with type 2 diabetes, according to the findings of a systematic review and meta-analysis.
Data from eight trials involving 77,242 patients showed that both drug classes significantly reduced the risk for major adverse cardiovascular events (MACE) to a similar degree: SGLT2 inhibitors by 11% and GLP-1 receptor agonists by 12%. However, this effect was limited to a 14% reduction for both drug classes in individuals with established atherosclerotic cardiovascular disease, whereas there was no effect in those without.
The researchers note that the study follow-ups were relatively short at 2 to 4 years and that a benefit in patients without established atherosclerosis may become apparent over the longer term, as was shown with dulaglutide over an 8-year period in the REWIND study, which was published after the analysis.
The drug class effects were similar for the individual MACE components of myocardial infarction and cardiovascular death, whereas stroke was significantly reduced by 14% with GLP-1 receptor agonists while SGLT2 inhibition reduced it by a nonsignificant 7%.
By contrast, hospitalization due to heart failure was reduced by a significant 31% with SGLT2 inhibitors, compared with a nonsignificant 7% with GLP-1 receptor agonists.
Both drug classes significantly reduced the risk for kidney disease progression, but the effect was greater with SGLT2 inhibitors, at 38% versus 18% with GLP-1 receptor agonists. And whereas GLP-1 receptor agonists primarily reduced macroalbuminuria, SGLT2 inhibitors also significantly decreased the chances of worsening estimated glomerular filtration rate, end-stage kidney disease, or renal death, by 45%.
“The prevention of heart failure and progression of kidney disease by SGLT2 [inhibitors] should be considered in the decision-making process when treating patients with [type 2 diabetes],” write Marc Sabatine (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and colleagues in Circulation.
They note that “the exact pathobiological explanations how these two drug classes exert their favourable effects are still unclear,” but suggest that “the natriuresis and inhibition of the tubuloglomerular feedback by SGLT2 [inhibitors] may play a central role and explain the observed reduction in [hospitalization for heart failure] and the delayed progression of diabetic kidney disease.”
The researchers now recommend head-to-head trials of the two drug classes and exploration of the potential combined effects of the two treatment regimens.
By Catherine Booth
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