No Differences in Kidney Function Decline Between People With Type 2 Diabetes Starting a Sodium-Glucose Cotransporter 2 Inhibitor or a Glucagon-like Peptide-1 Receptor Agonist: A Real-world Retrospective Comparative Observational Study.

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY Clinical therapeutics Pub Date : 2024-07-03 DOI:10.1016/j.clinthera.2024.04.009

Sara Bodini, Silvia Pieralice, Luca D'Onofrio, Carmen Mignogna, Lucia Coraggio, Rocco Amendolara, Renata Risi, Mauro Salducci, Raffaella Buzzetti, Ernesto Maddaloni

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Abstract

Purpose: Diabetic nephropathy represents the leading cause of end-stage kidney disease in developed countries. Cardiovascular outcome trials have found that in participants who received a glucagon-like peptide-1 receptor agonist (GLP1RA) and a sodium-glucose cotransporter 2 inhibitor (SGLT2i), the risk of incidence and progression of diabetic nephropathy in type 2 diabetes mellitus was reduced. The aim of this study was to compare the decline in estimated glomerular filtration rate (eGFR) among people taking a GLP1RA with that among people taking an SGLT2i in a real-world setting.

Methods: Data for 478 patients with type 2 diabetes mellitus who initiated therapy with a GLP1RA (n = 254) or an SGLT2i (n = 224) between January 1, 2018 and December 31, 2021 were extracted. The primary outcome was any reduction ≥30% in eGFR after the start of therapy. Weight loss and drug discontinuation were also assessed.

Findings: Over a median follow-up of 24 months, an eGFR reduction ≥30% occurred in 34 of 254 patients (13.4%) starting a GLP1RA and in 26 of 223 patients (11.6%) starting an SGLT2i (hazard ratio = 0.89; 95% CI, 0.54-1.49; P = 0.67). Median eGFR change over the whole follow-up was similar between groups (SGLT2i: median, -2 mL/min/1.73 m²; 25th, 75th percentile, -13, 8 mL/min/1.73 m²; GLP1RA: median, 0 mL/min/1.73 m²; 25th, 75th percentile, -10, 7 mL/min/1.73 m²; P = 0.54). No worsening of kidney function was observed, even when considering the ratio eGFR mean. The value of eGFR at baseline indicated a statistically significant indirect correlation with the observed absolute value of eGFR change over the follow-up (ρ = -0.36; P < 0.001). The difference in eGFR changes over time observed by eGFR categories was statistically significant (P = 0.0001) in both treatment groups. No significant differences in weight loss and drug discontinuations were observed between groups.

Implications: Although acting on different molecular mechanisms, both GLP1RA and SGLT2i might have similar effects on eGFR decline in diabetes, as suggested by the results of the present study conducted in a real-world setting. (Clin Ther. 2024;46:XXX-XXX) © 2024 Elsevier HS Journals, Inc.

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2型糖尿病患者开始服用钠-葡萄糖共转运体2抑制剂或胰高血糖素样肽-1受体激动剂后，肾功能衰退程度没有差异：一项真实世界的回顾性比较观察研究。

目的：糖尿病肾病是发达国家终末期肾病的主要病因。心血管结果试验发现，在接受胰高血糖素样肽-1受体激动剂（GLP1RA）和钠-葡萄糖共转运体2抑制剂（SGLT2i）治疗的患者中，2型糖尿病肾病的发病和恶化风险均有所降低。本研究的目的是比较在真实世界中服用 GLP1RA 与服用 SGLT2i 的患者估计肾小球滤过率（eGFR）的下降情况：提取了2018年1月1日至2021年12月31日期间开始接受GLP1RA（n = 254）或SGLT2i（n = 224）治疗的478名2型糖尿病患者的数据。主要结果是开始治疗后 eGFR 降低≥30%。此外，还对体重下降和停药情况进行了评估：在中位随访 24 个月期间，开始使用 GLP1RA 的 254 名患者中有 34 人（13.4%）的 eGFR 下降≥30%，开始使用 SGLT2i 的 223 名患者中有 26 人（11.6%）的 eGFR 下降≥30%（危险比 = 0.89；95% CI，0.54-1.49；P = 0.67）。两组患者在整个随访期间的 eGFR 变化中位数相似（SGLT2i：中位数，-2 mL/min/1.73 m2；第 25、75 百分位数，-13、8 mL/min/1.73 m2；GLP1RA：中位数，0 mL/min/1.73 m2；第 25、75 百分位数，-10、7 mL/min/1.73 m2；P = 0.54）。即使考虑到 eGFR 平均值比值，也未观察到肾功能恶化。基线时的 eGFR 值与随访期间观察到的 eGFR 绝对值变化有统计学意义的间接相关性（ρ = -0.36；P <0.001）。在两个治疗组中，按 eGFR 类别观察到的 eGFR 随时间变化的差异均具有统计学意义（P = 0.0001）。两组之间在体重减轻和停药方面无明显差异：意义：GLP1RA 和 SGLT2i 虽然作用于不同的分子机制，但可能对糖尿病患者的 eGFR 下降具有类似的作用，本研究的结果也表明了这一点。(Clin Ther. 2024;46:XXX-XXX) © 2024 Elsevier HS Journals, Inc.

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.