Real-World Data Find Few Differences in Cardiovascular Outcomes between SGLT2 Inhibitors and GLP1 Agonists
Presenter: Insiya Poonawalla, MD
Real-world data show higher treatment persistence with the sodium-glucose contransporter-2 (SGLT2) inhibitors compared with glucagon-like peptide-1 (GLP1 agonists) but equivalent cardiovascular outcomes between the two classes, with the exception of development of heart failure, which favors the SGLT2 inhibitors.
Investigators led by Insiya Poonawalla, MD, compared a series of outcomes between new users of SGLT2 inhibitors and GLP1 agonists, using medical and pharmacy claims data from the Humana Research Database, which includes data for approximately 13 million members.
The U.S. Food and Drug Administration has encouraged cardiovascular outcomes trials in an effort to enhance informed decision-making in the management of diabetes, said Dr. Poonawalla, a researcher at Humana Healthcare Research in Louisville, KY. The randomized controlled clinical trials show “a potential cardiovascular benefit with some of the agents in both of these therapeutic classes; however, population-based real-world evidence comparing these two classes on cardiovascular outcomes is limited, and also only focused on a few agents in both of these classes,” she said. Utilization and cost outcomes are even less studied.
Eligible patients were 18 to 89 years old, had a new claim for an SGLT2 inhibitor or GLP1 agonist from January 2015 to June 2017, had continuous enrollment pre- and post-index date for at least 12 months, and were treatment naïve to SGLT2 inhibitors or GLP1 agonists in the 6 months prior to the index date.
More than 13,000 patients met the inclusion criteria. Propensity score matching (1:1) was used to balance baseline characteristics between 5,507 patients in each treatment group.
The composite primary cardiovascular outcome of myocardial infarction or stroke or mortality occurred in 23.0% of the group taking GLP1 agonists versus 22.6% of those taking SGLT2 inhibitors. The composite secondary outcome of development of heart failure or death was achieved by 20.0% of the GLP1 agonist group compared with 17.9% of the SGLT2 inhibitor group (P = .005), driven by a significant reduction in occurrence of heart failure in patients taking SGLT2 inhibitors (18.8% vs. 16.3%; P < .001). Other individual components of the primary and secondary composite cardiovascular outcomes were not significantly different between the two treatment groups.
When accounting for time to event in an analytic model, no significant difference in cardiovascular outcomes was found between treatment classes when stratified by the presence or absence of established atherosclerotic cardiovascular disease at baseline.
Rates of treatment persistence were 40.4% and 36.1% (P < .001) among index users of SGLT2 inhibitors and GLP1 agonists, respectively. Treatment discontinuation was 15% more likely in those with index GLP1 agonist use (P < .001). The rate of inpatient stays was 11.9% in the SGLT2 inhibitor group versus 14.4% in the GLP1 agonist group (P < .001), and the rate of emergency department visits was 23.5% vs. 27.4% (P < .001), respectively.
Using the patients taking index SGLT2 inhibitors as the reference group, the mean difference in total per-person per-month (PPPM) cost was $179 higher (P < .001), the mean difference in medical PPPM cost was $70 higher (P < .001), and the mean difference in pharmacy PPPM cost was $108 higher (P < 0.001) in the GLP1 agonist group.
In addition to limitations characteristic of observational studies, Dr. Poonawalla cited lack of inclusion of newer agents in these classes (ie, semaglutide, ertugliflozin) due to a potential small sample and lack of sufficient follow-up.
Link to abstract: 36-OR: Comparative Effectiveness of SGLT2 Inhibitors vs. GLP-1 Agonists
Insiya Poonawalla, MD, reported nothing to disclose.