Donald Elena M, Driggin Elissa, Choe Jason, Batra Jaya, Vargas Fabian, Lindekens Jordan, Fried Justin A, Raikhelkar Jayant K, Bae David J, Oh Kyung T, Yuzefpolskaya Melana, Colombo Paolo C, Latif Farhana, Sayer Gabriel, Uriel Nir, Clerkin Kevin J, DeFilippis Ersilia M
Department of Medicine, Division of Cardiology New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.
Clin Transplant. 2024 Jul;38(7):e15401. doi: 10.1111/ctr.15401.
The use of glucagon-like-peptide 1 receptor agonists (GLP1-RA) has dramatically increased over the past 5 years for diabetes mellitus type 2 (T2DM) and obesity. These comorbidities are prevalent in adult heart transplant (HT) recipients. However, there are limited data evaluating the efficacy of this drug class in this population. The aim of the current study was to describe cardiometabolic changes in HT recipients prescribed GLP1-RA at a large-volume transplant center.
We retrospectively reviewed all adult HT recipients who received GLP1-RA after HT for a minimum of 1-month. Cardiometabolic parameters including body mass index (BMI), lipid panel, hemoglobin A1C, estimated glomerular filtration rate (eGFR), and NT-proBNP were compared prior to initiation of the drug and at most recent follow-up. We also evaluated for significant dose adjustments to immunosuppression after drug initiation and adverse effects leading to drug discontinuation.
Seventy-four patients were included (28% female, 53% White, 20% Hispanic) and followed for a median of 383 days [IQR 209, 613] on a GLP1-RA. The majority of patients (n = 56, 76%) were prescribed semaglutide. The most common indication for prescription was T2DM alone (n = 33, 45%), followed by combined T2DM and obesity (n = 26, 35%). At most recent follow-up, mean BMI decreased from 33.3 to 31.5 kg/m (p < 0.0001), HbA1C from 7.3% to 6.7% (p = 0.005), LDL from 78.6 to 70.3 mg/dL (p = 0.018) and basal insulin daily dose from 32.6 to 24.8 units (p = 0.0002).
HT recipients prescribed GLP1-RA therapy showed improved glycemic control, weight loss, and cholesterol levels during the study follow-up period. GLP1-RA were well tolerated and were rarely associated with changes in immunosuppression dosing.
在过去5年中，胰高血糖素样肽1受体激动剂（GLP1-RA）在2型糖尿病（T2DM）和肥胖症治疗中的使用显著增加。这些合并症在成人心脏移植（HT）受者中很常见。然而，评估这类药物在该人群中疗效的数据有限。本研究的目的是描述在一家大型移植中心接受GLP1-RA治疗的HT受者的心脏代谢变化。
我们回顾性分析了所有在心脏移植后接受GLP1-RA治疗至少1个月的成年HT受者。比较了开始用药前和最近一次随访时的心脏代谢参数，包括体重指数（BMI）、血脂谱、糖化血红蛋白A1C、估计肾小球滤过率（eGFR）和N末端脑钠肽前体（NT-proBNP）。我们还评估了用药后免疫抑制的显著剂量调整以及导致停药的不良反应。
纳入74例患者（28%为女性，53%为白人，20%为西班牙裔），接受GLP1-RA治疗的中位时间为383天[四分位间距209, 613]。大多数患者（n = 56, 76%）使用司美格鲁肽。最常见的处方适应证是单纯T2DM（n = 33, 45%），其次是T2DM合并肥胖（n = 26, 35%）。在最近一次随访时，平均BMI从33.3降至31.5 kg/m（p < 0.0001），糖化血红蛋白A1C从7.3%降至6.7%（p = 0.005），低密度脂蛋白从78.6降至70.3 mg/dL（p = 0.018），基础胰岛素每日剂量从32.6降至24.8单位（p = 0.0002）。
在研究随访期间，接受GLP1-RA治疗的HT受者血糖控制、体重减轻和胆固醇水平均有改善。GLP1-RA耐受性良好，很少与免疫抑制剂量的变化相关。
