Saeed Anum, Mulukutla Suresh R, Thoma Floyd, Lemon Lara, Koczo Agnes, Reis Steven, Marroquin Oscar, Kip Kevin
School of Medicine, University of Pittsburgh, and Heart and Vascular Institute, UPMC, Pittsburgh, Pennsylvania (A.S., A.K., S.R., O.M.).
School of Medicine, University of Pittsburgh; Heart and Vascular Institute, UPMC; and Clinical Analytics, UPMC, Pittsburgh, Pennsylvania (S.R.M.).
Ann Intern Med. 2025 Jul;178(7):930-939. doi: 10.7326/ANNALS-24-00775. Epub 2025 Jun 17.
Reduction of premature death and adverse cardiovascular outcomes is a key goal in type 2 diabetes management.
To compare mortality and cardiovascular event risks in patients treated with semaglutide versus empagliflozin and, secondarily, dulaglutide versus empagliflozin.
Target trial emulation studies from observational data comparing semaglutide- or dulaglutide-treated patients with propensity score-matched patients treated with empagliflozin.
Health care system of 703 academic and community clinical practices.
Patients aged 45 years or older with type 2 diabetes treated from 1 January 2019 to 31 December 2024 with semaglutide, dulaglutide, or empagliflozin.
Initial treatment with semaglutide, dulaglutide, or empagliflozin. At baseline, concomitant treatment with other diabetes medication was permitted, excluding other glucagon-like peptide-1 receptor agonists or sodium-glucose cotransporter-2 inhibitors.
A composite of death, myocardial infarction (MI), or stroke was the primary outcome, and secondary composite outcomes included death or MI, MI or stroke, and individual cardiac events.
Patients treated with semaglutide ( = 7899) versus empagliflozin ( = 7899) were followed for a median of 2.2 years; the respective rates of the composite of death, MI, or stroke were 3.7% versus 4.5% at 2 years and 5.9% versus 6.9% at 3 years. Corresponding incidence rates for the composite outcome were 20.99 versus 23.56 per 1000 person-years, with a hazard ratio (HR) of 0.89 (95% CI, 0.78 to 1.02). The HRs for the individual outcomes were 0.97 (CI, 0.81 to 1.15) for death, 0.85 (CI, 0.68 to 1.05) for MI, and 0.62 (CI, 0.43 to 0.89) for stroke. Risks for dulaglutide- and empagliflozin-treated patients were similar for the composite outcome (HR, 1.03 [CI, 0.90 to 1.16]) and for death, MI, and stroke separately.
Observational study design, lack of data on cause-specific mortality, and residual confounding.
Semaglutide treatment seems to confer some advantage over empagliflozin. This advantage was not observed for dulaglutide.
American Heart Association.
降低过早死亡和不良心血管结局是2型糖尿病管理的关键目标。
比较司美格鲁肽与恩格列净治疗患者的死亡率和心血管事件风险，其次比较度拉鲁肽与恩格列净治疗患者的死亡率和心血管事件风险。
基于观察数据的目标试验模拟研究，比较司美格鲁肽或度拉鲁肽治疗患者与倾向评分匹配的恩格列净治疗患者。
703家学术和社区临床实践的医疗保健系统。
2019年1月1日至2024年12月31日接受司美格鲁肽、度拉鲁肽或恩格列净治疗的45岁及以上2型糖尿病患者。
初始治疗采用司美格鲁肽、度拉鲁肽或恩格列净。在基线时，允许同时使用其他糖尿病药物，但不包括其他胰高血糖素样肽-1受体激动剂或钠-葡萄糖协同转运蛋白-2抑制剂。
主要结局为死亡、心肌梗死（MI）或中风的复合结局，次要复合结局包括死亡或MI、MI或中风以及个体心脏事件。
司美格鲁肽治疗患者（n = 7899）与恩格列净治疗患者（n = 7899）的中位随访时间为2.2年；2年时死亡、MI或中风复合结局的发生率分别为3.7%和4.5%，3年时分别为5.9%和6.9%。复合结局的相应发病率为每1000人年20.99例和23.56例，风险比（HR）为0.89（95%CI，0.78至1.02）。各单项结局的HR分别为：死亡0.97（CI，0.81至1.15）、MI 0.85（CI，0.68至1.05）、中风0.62（CI，0.43至0.89）。度拉鲁肽和恩格列净治疗患者的复合结局风险相似（HR，1.03 [CI，0.90至1.16]），死亡、MI和中风的风险也分别相似。
观察性研究设计、缺乏特定病因死亡率数据以及残余混杂因素。
司美格鲁肽治疗似乎比恩格列净具有一定优势。度拉鲁肽未观察到这种优势。
美国心脏协会。
