Comparison of the Effects of Glucagon-Like Peptide Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors for Prevention of Major Adverse Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-04, Vol.139 (17), p.2022-2031
• Main Authors: Zelniker, Thomas A, Wiviott, Stephen D, Raz, Itamar, Im, KyungAh, Goodrich, Erica L, Furtado, Remo H M, Bonaca, Marc P, Mosenzon, Ofri, Kato, Eri T, Cahn, Avivit, Bhatt, Deepak L, Leiter, Lawrence A, McGuire, Darren K, Wilding, John P H, Sabatine, Marc S
• Format: Article
• Language: English
• Subjects: Aged; Atherosclerosis - prevention & control; Cardiovascular Diseases - prevention & control; Clinical Trials as Topic; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetic Cardiomyopathies - etiology; Diabetic Cardiomyopathies - prevention & control; Diabetic Nephropathies - etiology; Diabetic Nephropathies - prevention & control; Female; Glucagon-Like Peptide Receptors - agonists; Humans; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Kidney Diseases - prevention & control; Male; Middle Aged; Proportional Hazards Models; Sodium-Glucose Transporter 2 Inhibitors - pharmacology; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
• ISSN: 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.118.038868

Glucagon-like peptide 1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as 2 new classes of antihyperglycemic agents that also reduce cardiovascular risk. The relative benefits in patients with and without established atherosclerotic cardiovascular disease for different outcomes with these classes of drugs remain undefined. We performed a systematic review and trial-level meta-analysis of GLP1-RA and SGLT2i cardiovascular outcomes trials using the PubMed and EMBASE databases (Excerpta Medica Database). The primary outcomes were the composite of myocardial infarction, stroke, and cardiovascular death (MACE); hospitalization for heart failure; and progression of kidney disease. In total, data from 8 trials and 77 242 patients, 42 920 (55.6%) in GLP1-RA trials, and 34 322 (44.4%) in SGLT2i trials, were included. Both drug classes reduced MACE in a similar magnitude with GLP1-RA reducing the risk by 12% (hazard ratio [HR], 0.88; 95% CI, 0.84-0.94; P