SGLT2 Inhibitors and GLP-1 Receptor Agonists Linked to Fewer COPD Exacerbations in diabetes patients with COPD: JAMA
Researchers had found in a new study that sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) associated with reduced risks of chronic obstructive pulmonary disease (COPD) exacerbations for patients with type 2 diabetes (T2D) and active COPD. This study was conducted by Avik Ray and fellow researchers published in JAMA Internal Medicine.
The authors used data from three large US insurance claims databases: Optum de identified Clinformatics Data Mart Database (2013-2023), IBM Health MarketScan (2013-2021), and Medicare fee-for-service (2013-2020). It was conducted as a comparative effectiveness research study with the help of three 1:1 propensity scores–matched cohort studies, simulating target trials comparing different glucose-lowering medications. The patients included were aged 40 years or more with a diagnosis of T2D and active COPD. Analysis was performed between January and June 2024.
Study Groups and Exposures
Patients were grouped into three groups for treatment comparison:
SGLT-2i vs DPP-4i: 27,991 matched pairs
GLP-1RA vs DPP-4i: 32,107 matched pairs
SGLT-2i vs GLP-1RA: 36,218 matched pairs
The first moderate or severe COPD exacerbation was the primary outcome, an outpatient visit for COPD with an oral glucocorticoid prescription or a hospitalization for COPD.
Key Results
Over a median follow-up of 145 days (IQR, 61-355), the study determined:
SGLT-2is vs DPP-4is:
COPD exacerbation rate: 9.26 vs 11.4 per 100 person-years (PYs)
Hazard ratio (HR): 0.81 (95% CI, 0.76-0.86)
Incidence rate difference (IRD): -2.20 per 100 PYs (95% CI, -2.83 to -1.58)
GLP-1RAs vs DPP-4is:
COPD exacerbation rate: 9.89 vs 11.49 per 100 PYs
HR: 0.86 (95% CI, 0.81-0.91)
IRD: -1.60 per 100 PYs (95% CI, -2.18 to -1.02)
SGLT-2is vs GLP-1RAs:
COPD exacerbation rate: 9.47 vs 10.00 per 100 PYs
HR: 0.94 (95% CI, 0.89-1.00)
IRD: -0.55 per 100 PYs (95% CI, -1.09 to -0.01)
The results of this comparative effectiveness research study suggest that SGLT-2is and GLP-1RAs were associated with a reduced risk of moderate or severe COPD exacerbations compared with dipeptidyl peptidase 4 inhibitors in adults with type 2 diabetes and active COPD. This may inform prescribing of glucose-lowering medications among patients with type 2 diabetes and active COPD.
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