medwireNews: People with type 2 diabetes treated with glucagon-like peptide (GLP)-1 receptor agonists have a lower risk for serious renal adverse events (AEs) than those given dipeptidyl peptidase (DPP)-4 inhibitors, indicate results from a Scandinavian real-world study.
These findings suggest “that the trial evidence of the renoprotective effects of GLP-1 receptor agonists may translate to clinical effectiveness with regard to serious renal complications,” say Peter Ueda (Karolinska Institutet, Stockholm, Sweden) and fellow researchers.
The registry study included 38,731 people from Norway, Sweden, or Denmark who initiated treatment with a GLP-1 receptor agonist between 2010 and 2016, and the same number of propensity score-matched individuals who were new users of DPP-4 inhibitors, chosen as a comparator for their neutral effect on renal outcomes. Patients were aged an average of 59 years, 18% had prior major cardiovascular disease, and 5% had a history of chronic kidney disease (CKD).
As reported in Diabetes Care, 1.47% of the GLP-1 receptor agonist users experienced the primary composite outcome of renal replacement therapy, death from renal causes, or hospitalization for renal events over an average follow-up of approximately 3 years, compared with 1.86% of those treated with DPP-4 inhibitors.
These findings translated into incidence rates of 4.8 and 6.3 events per 1000 person–years, respectively, and a significant 24% reduced risk for the composite renal outcome among GLP-1 receptor agonist users.
Ueda and colleagues say that this risk reduction was driven by associations between GLP-1 receptor agonist use and lower rates of the composite outcome during the first 2 years of observation, with no statistically significant associations observed during years 3–5 after study entry.
“[T]he findings of a differential association over time are likely explained by an on-treatment effect of GLP-1 receptor agonists and the relatively short duration of treatment for many of the patients,” they remark.
The team notes that although their study analyzed GLP-1 receptor agonists as a drug class, the majority (92.5%) of people taking these agents were on liraglutide, suggesting that the findings are “primarily applicable” to this drug. The association between GLP-1 receptor agonist use and reduced risk for adverse renal outcomes remained significant when the analysis was restricted to 35,081 liraglutide users and the same number of matched individuals taking DPP-4 inhibitors.
Ueda and team also observed a similar pattern of results in subgroup analyses by age, sex, and prior cardiovascular disease or CKD.
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