Patients with type 2 diabetes who started a sodium-glucose cotransporter-2 (SGLT-2) inhibitor had lower risk of being hospitalized for heart failure than those who started a glucagon-like peptide-1 (GLP-1) receptor agonist, a recent study found.
The cohort study used Medicare and two U.S. commercial claims data sets from April 2013 to December 2017 to evaluate whether SGLT-2 inhibitors and GLP-1 receptor agonists were associated with differential cardiovascular benefit. It included 156,825 patients with cardiovascular disease (CVD) at baseline (82,625 initiating SGLT-2s and 74,200 initiating GLP-1s) and 400,284 patients without baseline CVD (227,792 in the SGLT-2 group and 172,492 in the GLP-1 group). Results were published by Annals of Internal Medicine on Sept. 28.
In patients with CVD at baseline, starting an SGLT-2 inhibitor versus a GLP-1 receptor agonist was associated with a slightly lower risk for myocardial infarction or stroke (hazard ratio [HR], 0.90; 95% CI, 0.82 to 0.98), but this risk difference wasn't seen in those without CVD (HR, 1.07; 95% CI, 0.97 to 1.18). Regardless of CVD status, the initiation of an SGLT-2 inhibitor was associated with a reduction in hospitalization for heart failure, compared to GLP-1 receptor agonists (HRs, 0.71 [95% CI, 0.64 to 0.79] in patients with CVD and 0.69 [95% CI, 0.56 to 0.85] in those without).
The results “have important implications with respect to clinical decision making,” said the study authors, who noted that no randomized trials have compared the two drug classes head to head or are likely to do so. “Specifically, our findings suggest that the initiation of SGLT2 inhibitor therapy versus GLP-1 [receptor agonist] therapy in patients with [type 2 diabetes] who have no established CVD at baseline may have greater cardiovascular benefit,” they said, adding that their “real-world clinical data support the existing guidelines.”
The study did have several limitations, including that treatment selection was not randomized, so there may have been confounding despite adjustment, and that newer drugs from each class, including semaglutide and ertugliflozin, were not included.