Impact of dulaglutide on stroke risk in T2D patients

  • Gerstein HC & al.
  • Lancet Diabetes Endocrinol
  • 1 Feb 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes (T2D), long-term dulaglutide use may reduce ischaemic stroke incidence in middle-aged and older people but does not affect stroke severity.

Why this matters

  • Findings suggest that glucagon-like peptide 1 receptor agonists should be considered in future when developing guidelines for stroke prevention.

Study design

  • An exploratory analysis of the REWIND trial included 9901 patients with T2D and additional cardiovascular risk factors who were randomly assigned to receive either dulaglutide (n=4949) or placebo (n=4952).
  • Primary outcome: first occurrence of any component of the composite outcome (non-fatal myocardial infarction, non-fatal stroke, and mortality).
  • Funding: Eli Lilly and Company.

Key results

  • During a median follow-up of 5·4 (interquartile range [IQR], 5.1-5.9) years, cerebrovascular and other cardiovascular outcomes were ascertained and adjudicated.
  • Dulaglutide vs placebo group was significantly associated with reduction in the risk for:
    • stroke (HR, 0.76; 95% CI, 0.62-0.94; P=.010);
    • non-fatal stroke (HR, 0.76; 95% CI, 0.61-0.95; P=.017);
    • ischaemic stroke (HR, 0.75; 95% CI, 0.59-0.94; P=.012);
    • the composite of non-fatal stroke or all-cause mortality (HR, 0.88; 95% CI, 0.79-0.98; P=.017); and
    • disabling stroke (HR, 0.74; 95% CI, 0.56-0.99; P=.042).
  • Dulaglutide did not show any effects on haemorrhagic stroke (HR, 1.05; 95% CI, 0.55-1.99; P=.89), stroke of unknown type (HR, 0.82; 95% CI, 0.40-1.66; P=.58), and transient ischaemic attacks (HR, 0.79; 95% CI, 0.52-1.20; P=.27).
  • No significant difference was observed in the degree of disability after stroke between both the groups.

Limitations

  • Exploratory nature.