CVD benefits of newer T2D drugs are elusive for black patients

  • Mishriky BM & al.
  • Diabetes Obes Metab
  • 5 Jun 2019

  • International Clinical Digest
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Takeaway

  • Black patients in clinical trials of new type 2 diabetes (T2D) drugs do not experience cardiovascular disease (CVD) benefits that best placebo.
  • Data are from recent trials for glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium glucose co-transporter 2 inhibitors (SGLT-2is) showing significant overall reductions in CVD outcomes.
  • Meta-analysis authors say the data are underpowered for definitive conclusions because of underrepresentation of black patients.

Why this matters

  • Even though trials included mostly white patients, recent T2D guidelines generalize the results.  

Study design

  • Analysis, pooled data from 11 trials (5 GLP-1RAs, 2 SGLT-2is, 4 dipeptidyl peptidase-4 inhibitors [DPP-4is]); n=102,416 with T2D, 4.5% (n=4601) black.
  • Funding: None.

Key results

  • In pooled results, for black patients, drug vs placebo showed no significant overall difference for (relative risks, 95% CIs):
    • Major adverse cardiovascular events (MACEs): 0.94 (0.77-1.16); 
    • GLP-1RAs: 0.93 (0.66-1.32); 
    • SGLT-2is: 1.00 (0.47-2.14); or
    • DPP-4is: 0.96 (0.71-1.29).  
  • Across 6 trials showing significant overall MACE reductions, 163 cardiovascular (CV) events occurred among the black patients in treatment groups vs 164 with placebo.
  • For black patients in these trials, no significant difference for:
    • Drugs vs placebo: 0.97 (0.68-1.39); 
    • GLP-1RAs: 0.96 (0.61-1.53); or
    • SGLT-2is: 1.00 (0.47-2.14).

Limitations

  • 2 eligible trials lacked race data.
  • Significant intertrial heterogeneity.