| アブストラクト | INTRODUCTION: Clinical trials have demonstrated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes (T2D) who have established cardiovascular disease (CVD) or a high risk of CVD. Nevertheless, GLP-1RAs remain underutilized. This real-world, retrospective study compared cardiovascular and economic outcomes between individuals treated with GLP-1RAs and other glucose-lowering agents in England. METHODS: Clinical Practice Research Datalink-registered people indexed on GLP-1RAs, dipeptidyl peptidase-4 (DPP4) inhibitors, or basal insulin between January 1, 2014 and December 31, 2018 for their fourth line of T2D treatment were stratified into six cohorts based on their: (1) cardiovascular risk (high or very high risk) and (2) indexed therapy. Cox proportional hazards regression was used to compare the risk of MACE and all-cause death between GLP-1RA and other treatment cohorts. Generalized linear regression was used to quantify differences in healthcare resource use (HCRU) and costs between groups. RESULTS: Of 63,237 subjects, 10,607 were at high cardiovascular risk (GLP-1RA: 2709; DPP4 inhibitor: 2673; basal insulin: 5225) and 52,630 at very high cardiovascular risk (GLP-1RA: 14,692; DPP4 inhibitor: 18,461; basal insulin: 19,477). The crude incidence of all outcomes was lower in the GLP-1RA versus other treatment cohorts, regardless of cardiovascular risk. Among very-high-risk individuals treated with GLP-1RA, the adjusted risk of MACE was 33% (24-40%) and 23% (13-23%) lower versus DPP4 inhibitor and basal insulin cohorts, respectively. The adjusted total cardiovascular-related cost among very-high-risk individuals was pound208.14 ( pound155.81- pound260.47) and pound151.74 ( pound110.69- pound192.79) lower in the GLP-1RA versus DPP4 inhibitor or basal insulin cohorts, respectively. CONCLUSIONS: In a real-world setting, GLP-1RAs may be associated with a lower risk of MACE and reduced HCRU and costs than DPP4 inhibitors or basal insulin in individuals with T2D, particularly among those at very high cardiovascular risk. |
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| ジャーナル名 | Diabetes therapy : research, treatment and education of diabetes and related disorders |
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| Pubmed追加日 | 2025/3/21 |
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| 投稿者 | Connolly, Derek; Collins, Edward; Ren, Hongye; Wan Yau Ming, Simon; Davidson, Jennifer; Bain, Steve |
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| 組織名 | Birmingham City and Sandwell Hospitals, Birmingham, UK. d.l.connolly@bham.ac.uk.;Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.;d.l.connolly@bham.ac.uk.;Aston Medical School, Aston University, Birmingham, UK. d.l.connolly@bham.ac.uk.;Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.;Clinical Research Facility, Lyndon, West Bromwich, B71 4HJ, UK.;Novo Nordisk, Gatwick, UK.;Novo Nordisk A/S, Bagsvaerd, Denmark.;CorEvitas, Altrincham, UK.;Diabetes Research Unit, Swansea University Medical School, Swansea, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/40117087/ |
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