| アブストラクト | OBJECTIVE: To determine whether the combined use of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors is associated with a decreased risk of major adverse cardiovascular events and serious renal events compared with either drug class alone among patients with type 2 diabetes, and to assess the effect of the combination on the individual components of major adverse cardiovascular events, heart failure, and all cause mortality. DESIGN: Population based cohort study using a prevalent new-user design, emulating a trial. SETTING: UK Clinical Practice Research Datalink linked to Hospital Episode Statistics Admitted Patient Care and Office for National Statistics databases. PARTICIPANTS: Two prevalent new-user cohorts were assembled between January 2013 and December 2020, with follow-up until the end of March 2021. The first cohort included 6696 patients who started GLP-1 receptor agonists and added on SGLT-2 inhibitors, and the second included 8942 patients who started SGLT-2 inhibitors and added on GLP-1 receptor agonists. Combination users were matched, in a 1:1 ratio, to patients prescribed the same background drug, duration of background drug, and time conditional propensity score. MAIN OUTCOME MEASURES: Cox proportional hazards models were fitted to estimate the hazard ratios and 95% confidence intervals of major adverse cardiovascular events and serious renal events, separately, comparing the GLP-1 receptor agonist-SGLT-2 inhibitor combination with the background drug, either GLP-1 receptor agonists or SGLT-2 inhibitors, depending on the cohort. Secondary outcomes included associations with the individual components of major adverse cardiovascular events (myocardial infarction, ischaemic stroke, cardiovascular mortality), heart failure, and all cause mortality. RESULTS: Compared with GLP-1 receptor agonists, the SGLT-2 inhibitor-GLP-1 receptor agonist combination was associated with a 30% lower risk of major adverse cardiovascular events (7.0 v 10.3 events per 1000 person years; hazard ratio 0.70, 95% confidence interval 0.49 to 0.99) and a 57% lower risk of serious renal events (2.0 v 4.6 events per 1000 person years; hazard ratio 0.43, 0.23 to 0.80). Compared with SGLT-2 inhibitors, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a 29% lower risk of major adverse cardiovascular events (7.6 v 10.7 events per 1000 person years; hazard ratio 0.71, 0.52 to 0.98), whereas serious renal events generated a wide confidence interval (1.4 v 2.0 events per 1000 person years; hazard ratio 0.67, 0.32 to 1.41). Secondary outcomes generated similar results but with wider confidence intervals. CONCLUSIONS: In this cohort study, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a lower risk of major adverse cardiovascular events and serious renal events compared with either drug class alone. |
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| ジャーナル名 | BMJ (Clinical research ed.) |
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| 投稿日 | 2024/4/26 |
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| 投稿者 | Simms-Williams, Nikita; Treves, Nir; Yin, Hui; Lu, Sally; Yu, Oriana; Pradhan, Richeek; Renoux, Christel; Suissa, Samy; Azoulay, Laurent |
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| 組織名 | Institute of Applied Health Research College of Medical and Dental Sciences,;University of Birmingham, Birmingham, UK.;Department of Clinical Pharmacy, Hebrew University of Jerusalem, Jerusalem,;Israel.;Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,;Montreal, Canada.;Division of Endocrinology, Jewish General Hospital, Montreal, QC, Canada.;Department of Medicine, Brigham and Women's Hospital and Harvard Medical School,;Boston, MA, USA.;Department of Epidemiology, Biostatistics and Occupational Health, McGill;University, Montreal, QC, Canada.;Departments of Neurology and Neurosurgery, Jewish General Hospital, Montreal, QC,;Canada.;Montreal, Canada laurent.azoulay@mcgill.ca.;Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38663919/ |
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