"SGLT2i+GLP-1RA" combination therapy brings surprises!

Compiled and organized by Yimaitong, please do not reprint without authorization
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On April 2-4, the 2022 American College of Cardiology Annual Meeting (ACC2022) was successfully held in Washington, USA
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The ACC Annual Meeting is an educational and scientific society for interactive debates and discussions with the participation of global authoritative cardiovascular experts.
This meeting brings together nearly 20,000 experts and scholars from around the world
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At the meeting, Dr.
Persio D.
Lopez, a cardiologist at Mount Sinai Morningside Hospital and James J.
Peters VA Medical Center in New York City, presented a study that attracted widespread attention: in patients with type 2 diabetes complicated by atherosclerotic cardiovascular disease Disease (ASCVD) patients who received both a sodium-glucose transporter 2 inhibitor (SGLT2i) and a glucagon-like peptide-1 receptor agonist (GLP-1RA), "combined All-cause mortality was significantly reduced by 80% in the 1-year follow-up group
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Dr.
Persio D.
Lopez spoke about the study, Dr.
Lopez said, "This observational retrospective study used data collected from the Virginia National Database, which included 121,156 patients with type 2 diabetes and diagnosed ASCVD
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These patients were propensity score-matched and three subgroups (SGLT2i-treated, GLP-1 RA-treated, and combination-treated) were compiled, each including 5277 patients
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Parameters involved in score matching included age, sex, left ventricular ejection fraction, HbA1c level, systolic blood pressure, and the presence or absence of coronary artery disease or peripheral artery disease
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➤SGLT2i treatment group: patients received SGLT2i therapy; ➤GLP-1 RA treatment group: patients received GLP-1 RA therapy; ➤Combination therapy group: patients received SGLT2i+GLP-1 RA combination therapy
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Baseline characteristics: mean age of subjects was approximately 67 years; 97% male, mean BMI approximately 34 kg/m^2, mean HbA1c approximately 7.
9%, mean eGFR approximately 55-66mL/min/1.
73m^ 2.
The mean left ventricular ejection fraction was about 55%, and the median follow-up time was about 2.
5 years
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Study endpoints: The prespecified primary endpoint was the composite event rate of all-cause death, non-fatal myocardial infarction, or non-fatal stroke (at the first year of follow-up).
Follow-up analysis
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The most commonly prescribed SGLT2i is empagliflozin, and the common GLP-1RAs are liraglutide, semaglutide and dulaglutide in order, and the proportion of exenatide is less than 5%
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For other treatments, about 97% of patients were on statins, about 94% were on renin-angiotensin system inhibitors, about 90% were on metformin, and about 75% were on insulin, aspirin, and beta-blockers, Fewer people used other types of drugs
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"SGLT2i+GLP-1RA" combination therapy significantly reduces all-cause mortality! 1.
"Combination therapy" significantly reduced the composite endpoint by approximately 50%.
The data showed that the study's primary endpoint (1-year incidence of ASCVD composite events including all-cause death): ➤ Compared with patients using SGLT2i alone, the combination therapy group The primary endpoint was significantly reduced by 46%; ➤ was significantly reduced by 49% in the combination arm compared with patients on GLP-1 RA alone
;
Dr.
Lopez noted that the improvement in the composite endpoint was entirely driven by a reduction in all-cause mortality, with no significant difference between the combination and monotherapy in the incidence of non-fatal MI/stroke
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2.
"Combination therapy" significantly reduces the risk of all-cause mortality by about 80%.
The data show that for the endpoint of all-cause mortality (mortality at 1-year follow-up): ➤ Compared with patients who only use SGLT2i, the combination therapy group significantly reduces by 83%; ➤ Compared with patients who received GLP-1 RA but not other classes of drugs, the combination therapy group had an 81% reduction in mortality
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Combination therapy may bring more benefits, Dr.
Lopez mentioned in his speech, "We are not sure what drives patients to use these two drugs in combination, presumably because diabetes is difficult to control
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" "I am very interested in SGLT2i and GLP-1RA .
This drug combination is of great interest because most people with diabetes require more than one drug to control blood sugar
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Taken individually, each class reduces a patient's risk of adverse outcomes, including ASCVD, heart failure and renal insufficiency
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" Dr.
Virani, a cardiologist at the Michael E.
DeBakey VA Medical Center and professor of medicine at Baylor College of Medicine, commented
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Looking ahead, Dr.
Lopez cautioned that objective selection bias may have affected the study results, and that the study relied on administrative data rather than more detailed medical records or data collected in prospective studies, which need to be validated by prospective studies.

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In conclusion, this study demonstrates the health benefits of the "SGLT2i+GLP-1RA" combination therapy
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Compiled by: Mitchel L.
Zoler.
Combo of SGLT2 Inhibitor + GLP-1 RA Boosts Diabetes Survival [EB/OL].
[2022-4-15].
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