SGLT2 inhibitor, GLP-1 receptor agonist risk–benefits explored in older adults
medwireNews: Older people starting treatment with sodium-glucose cotransporter (SGLT)2 inhibitors have a lower risk for hospitalization for heart failure (HHF) than those starting glucagon-like peptide (GLP)-1 receptor agonists, research shows.
By contrast, there was no significant difference between the two groups in the risk for a composite outcome of myocardial infarction, stroke, or all-cause mortality, Elisabetta Patorno, from the Brigham and Women’s Hospital in Boston, Massachusetts, USA, told delegates at the 79th ADA Scientific Sessions in San Francisco, California, USA.
The findings are based on an analysis of 44,179 pairs of propensity score-matched Medicare patients aged 65 years and older with type 2 diabetes who initiated treatment between 2013 and 2016 with a SGLT2 inhibitor, typically canagliflozin, or a GLP-1 receptor agonist, typically liraglutide.
During a mean 8.5 months of follow-up, the rate of HHF was 4.99 per 1000 patient–years among people in the SGLT2 inhibitor group and 7.45 per 1000 patient–years among those in the GLP-1 receptor agonist group, which equated to a significant 34% reduced risk in the former group versus the latter.
The corresponding rates for the composite cardiovascular outcome were 23.13 and 22.12 events per 1000 person–years, a nonsignificant difference.
Further analysis of the individual cardiovascular outcomes revealed a significant 24% increased stroke risk with SGLT2 inhibitors relative to GLP-1 receptor agonists, but no difference in myocardial infarction or all-cause mortality rates.
Paterno also showed that although there was no significant difference in the composite cardiovascular outcome overall, people with no cardiovascular disease (CVD) at baseline had a significant 25% increased risk for this outcome when using SGLT2 inhibitors versus GLP-1 receptor agonists. By contrast, there was no difference between the two treatments among people who already had CVD.
Among the safety outcomes of interest, SGLT2 inhibitor use was associated with increased risks for diabetic ketoacidosis (hazard ratio [HR]=1.62) and lower limb amputation (HR=1.41), and no difference in risk for bone fracture or hypoglycemia relative to GLP-1 receptor agonist use.
As a secondary analysis, Paterno and colleagues compared the outcomes among SGLT2 inhibitor users with those among dipeptidyl peptidase (DPP)-4 inhibitors. The results were broadly similar to the primary data, with the exception of the composite cardiovascular outcome where people in the SGLT2 inhibitor group had a 23% decreased risk versus those in the DPP-4 inhibitor group, which was consistent regardless of baseline CVD.
By Laura Cowen
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