背景:新数据表明,胰高血糖素样肽-1受体激动剂(GLP-1RA)可改善2型糖尿病(T2D)患者的肾脏预后。GLP-1RA与钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)的肾脏和心血管有效性的直接比较,对这一人群的一线治疗,是需要的。
目的:作者比较了SGLT2i和GLP-1RA与T2D的新使用者的肾脏和心血管结局。
方法:使用倾向得分重叠加权,我们分析了2015年至2020年间导致PCRnet的20个美国卫生系统的电子健康记录数据.主要肾脏结局是由估计的肾小球滤过率(eGFR)持续下降40%组成的复合,终末期肾病,或全因死亡率超过2年或直到审查。此外,我们检查了心血管和安全性结局.
结果:加权研究队列包括35,004SGLT2i和47,268GLP-1RA起始剂。超过1.2年的中位数,治疗之间的主要结局没有差异(HR:0.91;95%CI:0.81-1.02),尽管SGLT2i与eGFR下降40%的较低风险相关(HR:0.77;95%CI:0.65~0.91).死亡风险(HR:1.08;95%CI:0.92-1.27),一个合成的行程,心肌梗塞,或死亡(HR:1.03;95%CI:0.93-1.14),和心力衰竭住院(HR:0.95;95%CI:0.80-1.13)没有差异。SGLT2i引发剂的生殖器真菌感染更为常见,但其他安全性结局没有差异.无论慢性肾脏疾病状态如何,结果相似。
结论:SGLT2i和GLP-1RA导致T2D患者的肾脏和心血管结局相似,尽管SGLT2i启动与eGFR下降40%的较低风险相关。(评估Empagliflozin在有和没有慢性肾脏疾病的2型糖尿病人群中的比较有效性;NCT05465317)。
BACKGROUND: Emerging data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve kidney outcomes for people with type 2 diabetes (T2D). Direct comparisons of the kidney and cardiovascular effectiveness of GLP-1 RA with sodium-glucose cotransporter 2 inhibitors (SGLT2i), a first-line therapy for this population, are needed.
OBJECTIVE: The authors compared kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D.
METHODS: Using propensity score overlap weighting, we analyzed electronic health record data from 20 U.S. health systems contributing to PCORnet between 2015 and 2020. The primary kidney outcome was a composite of sustained 40% estimated glomerular filtration rate (eGFR) decline, incident end-stage kidney disease, or all-cause mortality over 2 years or until censoring. In addition, we examined cardiovascular and safety outcomes.
RESULTS: The weighted study cohort included 35,004 SGLT2i and 47,268 GLP-1 RA initiators. Over a median of 1.2 years, the primary outcome did not differ between treatments (HR: 0.91; 95% CI: 0.81-1.02), although SGLT2i were associated with a lower risk of 40% eGFR decline (HR: 0.77; 95% CI: 0.65-0.91). Risks of mortality (HR: 1.08; 95% CI: 0.92-1.27), a composite of stroke, myocardial infarction, or death (HR: 1.03; 95% CI: 0.93-1.14), and heart failure hospitalization (HR: 0.95; 95% CI: 0.80-1.13) did not differ. Genital mycotic infections were more common for SGLT2i initiators, but other safety outcomes did not differ. The results were similar regardless of chronic kidney disease status.
CONCLUSIONS: SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline. (Evaluating Comparative Effectiveness of Empagliflozin in Type 2 Diabetes Population With and Without Chronic Kidney Disease; NCT05465317).