Diabetes research and clinical practice · 2025
Comparative effectiveness of GLP-1 receptor agonists on cardiovascular outcomes among adults with type 2 diabetes and moderate cardiovascular risk: emulation of a target trial.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Sklepinski Stacey M, Deng Yihong, Swarna Kavya Sindu, Herrin Jeph, Polley Eric C, Neumiller Joshua J, Galindo Rodolfo J, Umpierrez Guillermo E, Ross Joseph S, Borah Bijan J, Maron Bradley A, Mickelson Mindy M, McCoy Rozalina G
Аннотация
AIM: To compare the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP-1RAs) among adults with type 2 diabetes mellitus (T2D) at moderate cardiovascular risk.
METHODS: We emulated a target trial using claims data of adults with T2D at moderate cardiovascular risk who initiated dulaglutide, exenatide, liraglutide, or semaglutide between 01/01/2014-12/31/2021. Random treatment assignment was emulated by propensity scores and incorporated into inverse probability of treatment weighted (IPTW) Cox models. Outcomes were time to composite major adverse cardiovascular events (MACE: myocardial infarction, stroke, and all-cause mortality), expanded MACE (MACE, hospitalization for heart failure, and revascularization) and its components, and severe hypoglycemia.
RESULTS: After IPTW, 35,572 patients initiated dulaglutide, 4376 initiated exenatide, 8843 initiated liraglutide, and 33,063 initiated semaglutide. Compared to dulaglutide, semaglutide was associated with lower risk of MACE (HR 0.85, 95CI % 0.78-0.93), expanded MACE (HR 0.92, 95CI % 0.87-0.96), all-cause mortality (HR 0.81, 95CI % 0.71-0.92), stroke (HR 0.82, 95CI % 0.70-0.97), and revascularization (HR 0.93, 95CI % 0.88-0.99), while liraglutide was associated with lower risk of MACE (HR 0.84, 95CI % 0.72-0.97) and all-cause mortality (HR 0.79, 95CI % 0.64-0.99).
CONCLUSIONS: Among GLP-1RAs, semaglutide and liraglutide were associated with the greatest cardiovascular risk reduction in patients with T2D at moderate cardiovascular risk.
METHODS: We emulated a target trial using claims data of adults with T2D at moderate cardiovascular risk who initiated dulaglutide, exenatide, liraglutide, or semaglutide between 01/01/2014-12/31/2021. Random treatment assignment was emulated by propensity scores and incorporated into inverse probability of treatment weighted (IPTW) Cox models. Outcomes were time to composite major adverse cardiovascular events (MACE: myocardial infarction, stroke, and all-cause mortality), expanded MACE (MACE, hospitalization for heart failure, and revascularization) and its components, and severe hypoglycemia.
RESULTS: After IPTW, 35,572 patients initiated dulaglutide, 4376 initiated exenatide, 8843 initiated liraglutide, and 33,063 initiated semaglutide. Compared to dulaglutide, semaglutide was associated with lower risk of MACE (HR 0.85, 95CI % 0.78-0.93), expanded MACE (HR 0.92, 95CI % 0.87-0.96), all-cause mortality (HR 0.81, 95CI % 0.71-0.92), stroke (HR 0.82, 95CI % 0.70-0.97), and revascularization (HR 0.93, 95CI % 0.88-0.99), while liraglutide was associated with lower risk of MACE (HR 0.84, 95CI % 0.72-0.97) and all-cause mortality (HR 0.79, 95CI % 0.64-0.99).
CONCLUSIONS: Among GLP-1RAs, semaglutide and liraglutide were associated with the greatest cardiovascular risk reduction in patients with T2D at moderate cardiovascular risk.
Предметные рубрики MeSH
HumansDiabetes Mellitus, Type 2Glucagon-Like Peptide-1 Receptor AgonistsMaleFemaleCardiovascular DiseasesMiddle AgedHypoglycemic AgentsGlucagon-Like PeptidesLiraglutideExenatideRecombinant Fusion ProteinsAgedImmunoglobulin Fc FragmentsHeart Disease Risk FactorsTreatment OutcomeAdultGlucagon-Like Peptide 1Semaglutide