Multiple benefits found for GLP-1 receptor agonists

  • Kristensen SL & al.
  • Lancet Diabetes Endocrinol
  • 14 Aug 2019

  • International Clinical Digest
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Takeaway

  • An up-to-date meta-analysis shows cardiovascular (CV) and renal benefits of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with type 2 diabetes (T2D), without increasing hypoglycaemia or cancer risk.

Why this matters

  • Data on CV outcomes with GLP-1RAs have been inconsistent.

Study design

  • Meta-analysis of 7 trials with 56,004 patients.
  • Outcomes: all-cause death, composite kidney outcome (macroalbuminuria, worsening kidney function [serum creatinine doubling or ≥40% decline in estimated glomerular filtration rate], end-stage kidney disease, kidney-related death), heart failure hospitalisation.
  • Funding: None.

Key results

  • In pooled analysis, GLP-1RA treatment significantly reduced major adverse cardiovascular events:
    • HR, 0.88 (P<.0001>
    • Number needed to treat (NNT) to prevent 1 event: 75 (95% CI, 50-151).   
  • With GLP-1RAs, HRs were: 
    • CV death: 0.88 (P<.0001 and>
    • Fatal/nonfatal myocardial infarction: 0.91 (P=.043).
  • In 3.2 years of follow-up, with GLP-1RAs, risk reductions (HRs) seen in: 
    • All-cause death: 0.88 (P=.001), 
      • NNT to prevent 1 death: 108 (95% CI, 77-260);
    • Heart failure hospitalisation: 0.91 (P=.028),
      • NNT to prevent 1 event: 312 (95% CI, 165-2810); and
    • Composite kidney outcome: 0.83 (95% CI, 0.78-0.89).
  • Severe hypoglycaemia, pancreatitis, pancreatic cancer, and thyroid carcinoma rates did not differ between GLP-1RAs, placebo.

Limitations

  • No patient-level data.