Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.
Institute for Public Health and Medicine, Feinberg School of Medicine Northwestern University, Chicago, USA.
Endocrinol Diabetes Metab. 2023 May;6(3):e339. doi: 10.1002/edm2.339. Epub 2023 Feb 24.
There is limited research using real-world data to evaluate protective cardiovascular effects of glucagon-like peptide-1 (GLP-1) agonists among adults with type 2 diabetes (T2D) early in treatment.
We conducted a retrospective, active comparator cohort study using 2011-2015 administrative claims data to compare cardiovascular disease (CVD) event rates following initiation of exenatide extended-release (E-ER), exenatide immediate-release (E-IR) or liraglutide in T2D adults who previously received no other antidiabetic medication (ADM) except metformin. The primary outcome was time to first major adverse CVD event (ischaemic heart disease, stroke, congestive heart failure or peripheral arterial disease) after starting GLP-1. Cox proportional hazards regression was used to model the association between index GLP-1 and CVD events, adjusting for baseline patient, prescriber and plan characteristics. Primary analyses included all patients with ≥2 prescription fills for the index GLP-1, regardless of subsequent refill adherence or initiation of other ADM after index date.
Compared with liraglutide, neither E-ER nor E-IR was associated with risk of composite major CVD events (hazard ratios [HRs] for E-ER and E-IR: 1.33 [95% C.I. 0.73-2.39] and 1.30 [0.81-2.09]). No associations were observed between event rates for individual CVD components. The HR for an ischaemic event with E-IR relative to liraglutide was 1.85 (95% C.I. 0.97-3.53). Adjusting for time-varying exposure to other ADM and CVD medications after index date produced similar results.
Initiating either immediate or extended-release exenatide rather than liraglutide was not associated with significant differences in CVD risk in this observational real-world study.
利用真实世界数据评估 2 型糖尿病（T2D）患者早期接受胰高血糖素样肽-1（GLP-1）激动剂治疗的心血管保护作用的研究有限。
我们使用 2011 年至 2015 年的行政索赔数据进行了回顾性、活性对照队列研究，比较了在先前除二甲双胍外未接受任何其他抗糖尿病药物（ADM）治疗的 T2D 成人中，起始使用艾塞那肽延长释放（E-ER）、艾塞那肽即时释放（E-IR）或利拉鲁肽后心血管疾病（CVD）事件的发生率。主要结局是开始使用 GLP-1 后首次发生主要不良 CVD 事件（缺血性心脏病、中风、充血性心力衰竭或外周动脉疾病）的时间。使用 Cox 比例风险回归模型来模拟指数 GLP-1 与 CVD 事件之间的关联，调整基线患者、处方医生和计划特征。主要分析包括所有接受≥2 次指数 GLP-1 处方的患者，无论随后的指数日期后是否继续使用或开始使用其他 ADM。
与利拉鲁肽相比，E-ER 或 E-IR 均与复合主要 CVD 事件的风险无关（E-ER 和 E-IR 的风险比 [HRs]：1.33 [95%置信区间 0.73-2.39] 和 1.30 [0.81-2.09]）。未观察到单个 CVD 成分的事件发生率之间存在关联。E-IR 相对于利拉鲁肽的缺血性事件 HR 为 1.85（95%置信区间 0.97-3.53）。调整指数日期后其他 ADM 和 CVD 药物的时间变化暴露后，得到了类似的结果。
在这项观察性真实世界研究中，起始使用即时或延长释放艾塞那肽而不是利拉鲁肽与 CVD 风险无显著差异。
