在伴有慢性肾脏疾病的 2 型糖尿病患者中，联合钠-葡萄糖共转运蛋白 2 抑制剂和胰高血糖素样肽-1 受体激动剂治疗前的药物治疗对肾脏和心血管结局的影响。
Effect of preceding drug therapy on the renal and cardiovascular outcomes of combined sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist treatment in patients with type 2 diabetes and chronic kidney disease.
机构信息
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan.
出版信息
Diabetes Obes Metab. 2024 Aug;26(8):3248-3260. doi: 10.1111/dom.15652. Epub 2024 May 19.
AIM
To conduct a post hoc subgroup analysis of patients with type 2 diabetes (T2D) from the RECAP study, who were treated with sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide 1 receptor agonist (GLP-1RA) combination therapy, focusing only on those patients who had chronic kidney disease (CKD), to examine whether the composite renal outcome differed between those who received SGLT2 inhibitor treatment first and those who received a GLP-1RA first.
METHODS
We included 438 patients with CKD (GLP-1RA-first group, n = 223; SGLT2 inhibitor-first group, n = 215) from the 643 T2D patients in the RECAP study. The incidence of the composite renal outcome, defined as progression to macroalbuminuria and/or a ≥50% decrease in estimated glomerular filtration rate (eGFR), was analysed using a propensity score (PS)-matched model. Furthermore, we calculated the win ratio for these composite renal outcomes, which were weighted in the following order: (1) both a ≥50% decrease in eGFR and progression to macroalbuminuria; (2) a decrease in eGFR of ≥50% only; and (3) progression to macroalbuminuria only.
RESULTS
Using the PS-matched model, 132 patients from each group were paired. The incidence of renal composite outcomes did not differ between the two groups (GLP-1RA-first group, 10%; SGLT2 inhibitor-first group, 17%; odds ratio 1.80; 95% confidence interval [CI] 0.85 to 4.26; p = 0.12). The win ratio of the GLP-1RA-first group versus the SGLT2 inhibitor-first group was 1.83 (95% CI 1.71 to 1.95; p < 0.001).
CONCLUSION
Although the renal composite outcome did not differ between the two groups, the win ratio of the GLP-1RA-first group versus the SGLT2 inhibitor-first group was significant. These results suggest that, in GLP-1RA and SGLT2 inhibitor combination therapy, the addition of an SGLT2 inhibitor to baseline GLP-1RA treatment may lead to more favourable renal outcomes.
目的
对 RECAP 研究中接受钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂和胰高血糖素样肽 1 受体激动剂（GLP-1RA）联合治疗的 2 型糖尿病（T2D）患者进行事后亚组分析，重点关注患有慢性肾脏病（CKD）的患者，以检查在首先接受 SGLT2 抑制剂治疗和首先接受 GLP-1RA 治疗的患者之间，复合肾脏结局是否存在差异。
方法
我们纳入了 RECAP 研究中 643 例 T2D 患者中的 438 例 CKD 患者（GLP-1RA 首先治疗组，n=223；SGLT2 抑制剂首先治疗组，n=215）。使用倾向评分（PS）匹配模型分析复合肾脏结局的发生率，该结局定义为进展为大量白蛋白尿和/或估算肾小球滤过率（eGFR）下降≥50%。此外，我们计算了这些复合肾脏结局的赢比值，这些比值按以下顺序加权：（1）eGFR 下降≥50%且进展为大量白蛋白尿；（2）eGFR 下降≥50%；（3）仅进展为大量白蛋白尿。
结果
使用 PS 匹配模型，每组配对 132 例患者。两组之间肾脏复合结局的发生率无差异（GLP-1RA 首先治疗组 10%；SGLT2 抑制剂首先治疗组 17%；比值比 1.80；95%置信区间[CI] 0.85 至 4.26；p=0.12）。GLP-1RA 首先治疗组与 SGLT2 抑制剂首先治疗组的赢比值为 1.83（95%CI 1.71 至 1.95；p<0.001）。
结论
尽管两组之间的肾脏复合结局无差异，但 GLP-1RA 首先治疗组与 SGLT2 抑制剂首先治疗组的赢比值具有显著差异。这些结果表明，在 GLP-1RA 和 SGLT2 抑制剂联合治疗中，在基线 GLP-1RA 治疗的基础上添加 SGLT2 抑制剂可能会带来更有利的肾脏结局。
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