Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina USA.
J Am Coll Cardiol. 2024 Aug 20;84(8):696-708. doi: 10.1016/j.jacc.2024.06.016.
BACKGROUND: Emerging data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve kidney outcomes for people with type 2 diabetes (T2D). Direct comparisons of the kidney and cardiovascular effectiveness of GLP-1 RA with sodium-glucose cotransporter 2 inhibitors (SGLT2i), a first-line therapy for this population, are needed. OBJECTIVES: The authors compared kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D. METHODS: Using propensity score overlap weighting, we analyzed electronic health record data from 20 U.S. health systems contributing to PCORnet between 2015 and 2020. The primary kidney outcome was a composite of sustained 40% estimated glomerular filtration rate (eGFR) decline, incident end-stage kidney disease, or all-cause mortality over 2 years or until censoring. In addition, we examined cardiovascular and safety outcomes. RESULTS: The weighted study cohort included 35,004 SGLT2i and 47,268 GLP-1 RA initiators. Over a median of 1.2 years, the primary outcome did not differ between treatments (HR: 0.91; 95% CI: 0.81-1.02), although SGLT2i were associated with a lower risk of 40% eGFR decline (HR: 0.77; 95% CI: 0.65-0.91). Risks of mortality (HR: 1.08; 95% CI: 0.92-1.27), a composite of stroke, myocardial infarction, or death (HR: 1.03; 95% CI: 0.93-1.14), and heart failure hospitalization (HR: 0.95; 95% CI: 0.80-1.13) did not differ. Genital mycotic infections were more common for SGLT2i initiators, but other safety outcomes did not differ. The results were similar regardless of chronic kidney disease status. CONCLUSIONS: SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline. (Evaluating Comparative Effectiveness of Empagliflozin in Type 2 Diabetes Population With and Without Chronic Kidney Disease; NCT05465317).
背景：新出现的数据表明，胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）可改善 2 型糖尿病（T2D）患者的肾脏结局。需要对 GLP-1 RA 与钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）的肾脏和心血管效果进行直接比较，SGLT2i 是该人群的一线治疗药物。 目的：作者比较了新使用 SGLT2i 和 GLP-1 RA 的 T2D 患者的肾脏和心血管结局。 方法：使用倾向评分重叠加权法，我们分析了 2015 年至 2020 年期间参与 PCORnet 的 20 个美国医疗系统的电子健康记录数据。主要肾脏结局是在 2 年内或截止前持续 40%估算肾小球滤过率（eGFR）下降、终末期肾病或全因死亡率的复合指标。此外，我们还检查了心血管和安全性结局。 结果：加权研究队列包括 35004 名 SGLT2i 和 47268 名 GLP-1 RA 使用者。中位随访时间为 1.2 年，两种治疗方法的主要结局无差异（HR：0.91；95%CI：0.81-1.02），尽管 SGLT2i 与 40%eGFR 下降风险降低相关（HR：0.77；95%CI：0.65-0.91）。死亡率（HR：1.08；95%CI：0.92-1.27）、卒中、心肌梗死或死亡的复合指标（HR：1.03；95%CI：0.93-1.14）和心力衰竭住院（HR：0.95；95%CI：0.80-1.13）风险无差异。SGLT2i 使用者的生殖器霉菌感染更为常见，但其他安全性结局无差异。无论慢性肾脏病状况如何，结果均相似。 结论：在 T2D 患者中，SGLT2i 和 GLP-1 RA 导致相似的肾脏和心血管结局，尽管 SGLT2i 起始治疗与 40%eGFR 下降风险降低相关。（评估恩格列净在有和无慢性肾脏病的 2 型糖尿病患者中的疗效比较；NCT05465317）。
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