■尽管已证明其在改善心血管风险方面的益处,与胰高血糖素样肽1受体激动剂(GLP-1RAs)相比,替利西帕肽与死亡率以及心血管和肾脏结局的关系尚不清楚.
■探讨2型糖尿病患者与GLP-1RA相比,替瑞哌肽与死亡率、心血管和肾脏不良结局的关系。
■这项回顾性队列研究使用了美国TriNetX协作网络数据,该数据是在2022年6月1日至2023年6月30日之间从18岁或18岁以上的2型糖尿病患者中收集的,开始服用替拉肽或GLP-1RA;基线无5期慢性肾脏疾病或肾衰竭;药物开始后60天内无心肌梗死或缺血性或出血性中风。
■与GLP-1RA相比,使用替拉肽治疗。
■主要结局是全因死亡率,次要结局包括主要不良心血管事件(MACEs),MACE和全因死亡率的复合,肾脏事件,急性肾损伤,和主要不良肾脏事件。使用Cox比例风险回归模型分析所有结果。
■有14834例患者接受了替利西帕肽治疗(平均[SD]年龄,55.4[11.8]岁;8444[56.9%]女性)和125474接受GLP-1RA治疗(平均[SD]年龄,58.1[13.3]岁;67474[53.8%]女性)。在中位(IQR)随访10.5(5.2-15.7)个月后,替拉肽组95例(0.6%)患者死亡,GLP-1RA组166例(1.1%)患者死亡。Tirzepatide治疗与全因死亡率风险较低相关(调整后的风险比[AHR],0.58;95%CI,0.45-0.75),MACE(AHR,0.80;95%CI,0.71-0.91),MACE和全因死亡率的复合(AHR,0.76;95%CI,0.68-0.84),肾脏事件(AHR,0.52;95%CI,0.37-0.73),急性肾损伤(AHR,0.78;95%CI,0.70-0.88),和主要不良肾脏事件(AHR,0.54;95%CI,0.44-0.67)。用替利西帕肽治疗与糖化血红蛋白的更大下降相关(治疗差异,-0.34个百分点;95%CI,-0.44至-0.24个百分点)和体重(治疗差异,-2.9kg,与GLP-1RA相比,95%CI,-4.8至-1.1kg)。亚组分析的交互检验显示了通过估计的肾小球滤过率分层的一致结果,糖化血红蛋白水平,身体质量指数,喜剧,和合并症。
■在这项研究中,使用替利平肽治疗的全因死亡率风险较低,不良心血管事件,急性肾损伤,与GLP-1RA相比,2型糖尿病患者的不良肾脏事件。这些发现支持将替利西帕肽整合到该人群的治疗策略中。
UNASSIGNED: Despite its demonstrated benefits in improving cardiovascular risk profiles, the association of tirzepatide with mortality and cardiovascular and kidney outcomes compared with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) remains unknown.
UNASSIGNED: To investigate the association of tirzepatide with mortality and adverse cardiovascular and kidney outcomes compared with GLP-1 RAs in patients with type 2 diabetes.
UNASSIGNED: This retrospective cohort study used US Collaborative Network of TriNetX data collected on individuals with type 2 diabetes aged 18 years or older initiating tirzepatide or GLP-1 RA between June 1, 2022, and June 30, 2023; without stage 5 chronic kidney disease or kidney failure at baseline; and without myocardial infarction or ischemic or hemorrhagic stroke within 60 days of drug initiation.
UNASSIGNED: Treatment with tirzepatide compared with GLP-1 RA.
UNASSIGNED: The primary outcome was all-cause mortality, and secondary outcomes included major adverse cardiovascular events (MACEs), the composite of MACEs and all-cause mortality, kidney events, acute kidney injury, and major adverse kidney events. All outcomes were analyzed using Cox proportional hazards regression models.
UNASSIGNED: There were 14 834 patients treated with tirzepatide (mean [SD] age, 55.4 [11.8] years; 8444 [56.9%] female) and 125 474 treated with GLP-1 RA (mean [SD] age, 58.1 [13.3] years; 67 474 [53.8%] female). After a median (IQR) follow-up of 10.5 (5.2-15.7) months, 95 patients (0.6%) in the tirzepatide group and 166 (1.1%) in the GLP-1 RA group died. Tirzepatide treatment was associated with lower hazards of all-cause mortality (adjusted hazard ratio [AHR], 0.58; 95% CI, 0.45-0.75), MACEs (AHR, 0.80; 95% CI, 0.71-0.91), the composite of MACEs and all-cause mortality (AHR, 0.76; 95% CI, 0.68-0.84), kidney events (AHR, 0.52; 95% CI, 0.37-0.73), acute kidney injury (AHR, 0.78; 95% CI, 0.70-0.88), and major adverse kidney events (AHR, 0.54; 95% CI, 0.44-0.67). Treatment with tirzepatide was associated with greater decreases in glycated hemoglobin (treatment difference, -0.34 percentage points; 95% CI, -0.44 to -0.24 percentage points) and body weight (treatment difference, -2.9 kg, 95% CI, -4.8 to -1.1 kg) compared with GLP-1 RA. An interaction test for subgroup analysis revealed consistent results stratified by estimated glomerular filtration rate, glycated hemoglobin level, body mass index, comedications, and comorbidities.
UNASSIGNED: In this study, treatment with tirzepatide was associated with lower hazards of all-cause mortality, adverse cardiovascular events, acute kidney injury, and adverse kidney events compared with GLP-1 RA in patients with type 2 diabetes. These findings support the integration of tirzepatide into therapeutic strategies for this population.