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GLP-1 Receptor Agonists Have better Outcomes Than DPP4 Inhibitors in T2D patients & CKD
Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are contributors to the health burden and are associated with increased mortality and cardiovascular events. Type 2 diabetes is the most common cause of CKD, and both diabetes and CKD are associated with increased all-cause mortality and increased rates of infection and cardiovascular events.
A recent study suggests that the use of GLP-1 receptor agonists was associated with better outcomes compared with the use of DPP-4 inhibitors among patients with type 2 diabetes and advanced-stage chronic kidney disease. The study findings were published in the JAMA Network Open on March 07, 2022.
Unlike SGLT-2 inhibitors, GLP-1 receptor agonists can be used in patients with advanced-stage CKD or ESKD. However, real-world studies comparing GLP-1 receptor agonists with DPP-4 inhibitors for the treatment of patients with advanced-stage CKD or ESKD are rare. Therefore, Dr Jia-Jin Chen and his team conducted to assess, whether the use of GLP-1 receptor agonists in a population with diabetes and advanced-stage CKD or ESKD is associated with better outcomes compared with the use of DPP-4 inhibitors.
In a retrospective cohort study, the researchers used data of 27 279 patients with type 2 diabetes and stage 5 CKD or ESKD from the National Health Insurance Research Database of Taiwan. They compared treatment with GLP-1 receptor agonists (n= 701) and treatment with DPP-4 inhibitors (n= 26 578). The researchers further compared all-cause mortality, sepsis- and infection-related mortality, and mortality related to major adverse cardiovascular and cerebrovascular events between patients treated with GLP-1 receptor agonists and patients treated with DPP-4 inhibitors. They used propensity score weighting to mitigate the imbalance among covariates between the groups.
Key findings of the study:
- After weighting, the researchers found that the use of GLP-1 receptor agonists was associated with lower all-cause mortality (hazard ratio [HR], 0.79) and lower sepsis- and infection-related mortality (HR, 0.61).
- Upon subgroup analysis, they observed a lower risk of mortality associated with the use of GLP-1 receptor agonists compared with DDP-4 inhibitors among patients with cerebrovascular disease (HR, 0.33) than among those without the cerebrovascular disease (HR, 0.89).
The authors concluded, "Treatment with GLP-1 receptor agonists was associated with lower all-cause mortality among patients with type 2 diabetes, advanced-stage CKD, and ESKD than was treatment with DPP-4 inhibitors. Additional well-designed, prospective studies are needed to confirm the potential benefit of GLP-1 receptor agonist treatment for patients with advanced CKD or ESKD."
For further information:
DOI: 10.1001/jamanetworkopen.2022.1169
Keywords: CKD, ESKD, GLP-1 receptor agonist, DPP-4 inhibitors, type 2 diabetes, JAMA Network Open, chronic kidney disease, end-stage kidney disease, National Health Insurance Research Database of Taiwan, MACCE, Mortality rate.
Dr Kartikeya Kohli is an Internal Medicine Consultant at Sitaram Bhartia Hospital in Delhi with super speciality training in Nephrology. He has worked with various eminent hospitals like Indraprastha Apollo Hospital, Sir Gangaram Hospital. He holds an MBBS from Kasturba Medical College Manipal, DNB Internal Medicine, Post Graduate Diploma in Clinical Research and Business Development, Fellow DNB Nephrology, MRCP and ECFMG Certification. He has been closely associated with India Medical Association South Delhi Branch and Delhi Medical Association and has been organising continuing medical education programs on their behalf from time to time. Further he has been contributing medical articles for their newsletters as well. He is also associated with electronic media and TV for conduction and presentation of health programs. He has been associated with Medical Dialogues for last 3 years and contributing articles on regular basis.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751