Journal of neurology · 2025
Outcomes of GLP-1 receptor agonist use following ischemic stroke: a propensity score-matched real-world analysis.
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Rai Pranjal, Bathla Girish, Praveen Niharika, Gopikonda Shreya Sri, Chen Huanwen Alvin, Salim Hamza A, Azzam Ahmed, Essibayi Muhammed Amir, Altschul David J, Dmytriw Adam A, Yedavalli Vivek S, Latifi Shahrzad, Malhotra Ajay, Colasurdo Marco, Gandhi Dheeraj, Lakhani Dhairya A
Аннотация
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1As) have been shown to be beneficial in primary stroke prevention for high-risk patients. However, their benefits following major ischemic events are unclear. Herein, we present real-world analysis assessing outcomes of GLP-1A following major ischemic event.
METHODS: This retrospective cohort study utilized the TriNetX platform. Adults (≥ 18 years) with AIS treated with intravenous thrombolysis (IVT) were identified; exposure was any US FDA-approved GLP-1A initiated within 6 months of the index stroke. The comparator was IVT-treated patients without GLP-1A exposure. Outcomes assessed at 5 years included major adverse health-care events (MAHEs): number of emergency department (ED) visits and inpatient hospitalizations, and all-cause mortality. One-to-one propensity score matching balanced baseline characteristics. We estimated risk difference/risk ratio/odds ratio, 5-year Kaplan-Meier (KM) event probabilities with log-rank tests, and Cox hazard ratios (HRs) with 95% CIs; small cells (≤ 10) were masked per data-use agreement.
RESULTS: Of 69,005 eligible patients, 549 received GLP-1A and 68,938 did not; after matching, 432 per group were analyzed. GLP-1A exposure was associated with lower all-cause mortality (7.4% vs 14.1%; HR 0.61, 95% CI 0.39-0.93), lower ED visits (37% vs 47%; HR 0.78, 95% CI 0.63-0.95), and lower inpatient hospitalizations (31.9% vs 45.4%; HR 0.69, 95% CI 0.55-0.85); KM log-rank p ≤ 0.05 for all. Median time to first MAHE was longer with GLP-1A (1293 vs 897 days for hospitalization and 886 vs 603 days for ED visits).
CONCLUSIONS: GLP-1A therapy after IVT is associated with favorable long-term safety and utilization signals and warrants confirmation in a prospective study with standardized initiation.
METHODS: This retrospective cohort study utilized the TriNetX platform. Adults (≥ 18 years) with AIS treated with intravenous thrombolysis (IVT) were identified; exposure was any US FDA-approved GLP-1A initiated within 6 months of the index stroke. The comparator was IVT-treated patients without GLP-1A exposure. Outcomes assessed at 5 years included major adverse health-care events (MAHEs): number of emergency department (ED) visits and inpatient hospitalizations, and all-cause mortality. One-to-one propensity score matching balanced baseline characteristics. We estimated risk difference/risk ratio/odds ratio, 5-year Kaplan-Meier (KM) event probabilities with log-rank tests, and Cox hazard ratios (HRs) with 95% CIs; small cells (≤ 10) were masked per data-use agreement.
RESULTS: Of 69,005 eligible patients, 549 received GLP-1A and 68,938 did not; after matching, 432 per group were analyzed. GLP-1A exposure was associated with lower all-cause mortality (7.4% vs 14.1%; HR 0.61, 95% CI 0.39-0.93), lower ED visits (37% vs 47%; HR 0.78, 95% CI 0.63-0.95), and lower inpatient hospitalizations (31.9% vs 45.4%; HR 0.69, 95% CI 0.55-0.85); KM log-rank p ≤ 0.05 for all. Median time to first MAHE was longer with GLP-1A (1293 vs 897 days for hospitalization and 886 vs 603 days for ED visits).
CONCLUSIONS: GLP-1A therapy after IVT is associated with favorable long-term safety and utilization signals and warrants confirmation in a prospective study with standardized initiation.