Abstract：
OBJECTIVE: Diabetic nephropathy represents the leading cause of end-stage kidney disease in developed countries. Cardiovascular outcome trials have found that in participants who received a glucagon-like peptide-1 receptor agonist (GLP1RA) and a sodium-glucose cotransporter 2 inhibitor (SGLT2i), the risk of incidence and progression of diabetic nephropathy in type 2 diabetes mellitus was reduced. The aim of this study was to compare the decline in estimated glomerular filtration rate (eGFR) among people taking a GLP1RA with that among people taking an SGLT2i in a real-world setting.
METHODS: Data for 478 patients with type 2 diabetes mellitus who initiated therapy with a GLP1RA (n = 254) or an SGLT2i (n = 224) between January 1, 2018 and December 31, 2021 were extracted. The primary outcome was any reduction ≥30% in eGFR after the start of therapy. Weight loss and drug discontinuation were also assessed.
RESULTS: Over a median follow-up of 24 months, an eGFR reduction ≥30% occurred in 34 of 254 patients (13.4%) starting a GLP1RA and in 26 of 223 patients (11.6%) starting an SGLT2i (hazard ratio = 0.89; 95% CI, 0.54-1.49; P = 0.67). Median eGFR change over the whole follow-up was similar between groups (SGLT2i: median, -2 mL/min/1.73 m2; 25th, 75th percentile, -13, 8 mL/min/1.73 m2; GLP1RA: median, 0 mL/min/1.73 m2; 25th, 75th percentile, -10, 7 mL/min/1.73 m2; P = 0.54). No worsening of kidney function was observed, even when considering the ratio eGFR mean. The value of eGFR at baseline indicated a statistically significant indirect correlation with the observed absolute value of eGFR change over the follow-up (ρ = -0.36; P < 0.001). The difference in eGFR changes over time observed by eGFR categories was statistically significant (P = 0.0001) in both treatment groups. No significant differences in weight loss and drug discontinuations were observed between groups.
CONCLUSIONS: Although acting on different molecular mechanisms, both GLP1RA and SGLT2i might have similar effects on eGFR decline in diabetes, as suggested by the results of the present study conducted in a real-world setting. (Clin Ther. 2024;46:XXX-XXX) © 2024 Elsevier HS Journals, Inc.
METHODS: Data for 478 patients with type 2 diabetes mellitus who initiated therapy with a GLP1RA (n = 254) or an SGLT2i (n = 224) between January 1, 2018 and December 31, 2021 were extracted. The primary outcome was any reduction ≥30% in eGFR after the start of therapy. Weight loss and drug discontinuation were also assessed.
RESULTS: Over a median follow-up of 24 months, an eGFR reduction ≥30% occurred in 34 of 254 patients (13.4%) starting a GLP1RA and in 26 of 223 patients (11.6%) starting an SGLT2i (hazard ratio = 0.89; 95% CI, 0.54-1.49; P = 0.67). Median eGFR change over the whole follow-up was similar between groups (SGLT2i: median, -2 mL/min/1.73 m2; 25th, 75th percentile, -13, 8 mL/min/1.73 m2; GLP1RA: median, 0 mL/min/1.73 m2; 25th, 75th percentile, -10, 7 mL/min/1.73 m2; P = 0.54). No worsening of kidney function was observed, even when considering the ratio eGFR mean. The value of eGFR at baseline indicated a statistically significant indirect correlation with the observed absolute value of eGFR change over the follow-up (ρ = -0.36; P < 0.001). The difference in eGFR changes over time observed by eGFR categories was statistically significant (P = 0.0001) in both treatment groups. No significant differences in weight loss and drug discontinuations were observed between groups.
CONCLUSIONS: Although acting on different molecular mechanisms, both GLP1RA and SGLT2i might have similar effects on eGFR decline in diabetes, as suggested by the results of the present study conducted in a real-world setting. (Clin Ther. 2024;46:XXX-XXX) © 2024 Elsevier HS Journals, Inc.
摘要：
目的：在发达国家，糖尿病肾病是导致终末期肾病的主要原因。心血管结局试验发现，在接受胰高血糖素样肽-1受体激动剂（GLP1RA）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的参与者中，2型糖尿病患者糖尿病肾病的发生率和进展风险降低.这项研究的目的是比较在现实世界中服用GLP1RA的人与服用SGLT2i的人之间估计的肾小球滤过率（eGFR）的下降。
方法：提取了2018年1月1日至2021年12月31日期间开始使用GLP1RA（n=254）或SGLT2i（n=224）治疗的478例2型糖尿病患者的数据。主要结果是治疗开始后eGFR的任何降低≥30%。还评估了体重减轻和药物停药。
结果：在24个月的中位随访时间内，开始GLP1RA的254例患者中有34例(13.4%)和开始SGLT2i的223例患者中有26例(11.6%)eGFR降低≥30%(风险比=0.89;95%CI,0.54-1.49;P=0.67).整个随访期间的eGFR中位数变化在组间相似(SGLT2i：中位数，-2mL/min/1.73m2;25,第75百分位数,-13,8mL/min/1.73m2;GLP1RA:中位数,0mL/min/1.73m2;第25,第75百分位数,-10,7mL/min/1.73m2;P=0.54)。未观察到肾功能恶化，即使考虑到eGFR的比值。基线时的eGFR值表明与随访中观察到的eGFR变化的绝对值有统计学意义的间接相关性(ρ=-0.36;P<0.001)。在两个治疗组中，通过eGFR类别观察到的eGFR随时间变化的差异具有统计学意义（P=0.0001）。两组之间的体重减轻和药物停药没有显着差异。
结论：尽管作用于不同的分子机制，GLP1RA和SGLT2i可能对糖尿病患者eGFR下降有相似的影响，正如在现实世界中进行的本研究的结果所建议的那样。（ClinTher。2024；46：XXX-XXX）©2024ElsevierHS期刊，Inc.
方法：提取了2018年1月1日至2021年12月31日期间开始使用GLP1RA（n=254）或SGLT2i（n=224）治疗的478例2型糖尿病患者的数据。主要结果是治疗开始后eGFR的任何降低≥30%。还评估了体重减轻和药物停药。
结果：在24个月的中位随访时间内，开始GLP1RA的254例患者中有34例(13.4%)和开始SGLT2i的223例患者中有26例(11.6%)eGFR降低≥30%(风险比=0.89;95%CI,0.54-1.49;P=0.67).整个随访期间的eGFR中位数变化在组间相似(SGLT2i：中位数，-2mL/min/1.73m2;25,第75百分位数,-13,8mL/min/1.73m2;GLP1RA:中位数,0mL/min/1.73m2;第25,第75百分位数,-10,7mL/min/1.73m2;P=0.54)。未观察到肾功能恶化，即使考虑到eGFR的比值。基线时的eGFR值表明与随访中观察到的eGFR变化的绝对值有统计学意义的间接相关性(ρ=-0.36;P<0.001)。在两个治疗组中，通过eGFR类别观察到的eGFR随时间变化的差异具有统计学意义（P=0.0001）。两组之间的体重减轻和药物停药没有显着差异。
结论：尽管作用于不同的分子机制，GLP1RA和SGLT2i可能对糖尿病患者eGFR下降有相似的影响，正如在现实世界中进行的本研究的结果所建议的那样。（ClinTher。2024；46：XXX-XXX）©2024ElsevierHS期刊，Inc.
