1. Reduction of Cardiovascular Risk and Improved Estimated Glomerular Filtration Rate by SGLT2 Inhibitors, Including Dapagliflozin, Is Consistent Across the Class
- Author
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Robert C. Penland, Robert Fox, Rury R. Holman, Adrian F. Hernandez, David W. Boulton, Weifeng Tang, Hiddo J.L. Heerspink, Robert J. Mentz, Srinivas Bachina, Lindsay E. Clegg, Marcus Thuresson, Peter Fenici, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Kidney Center (GKC), and Methods in Medicines evaluation & Outcomes research (M2O)
- Subjects
Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Urology ,030209 endocrinology & metabolism ,Placebo ,Lower risk ,Kidney ,Placebos ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Glucosides ,Risk Factors ,Post-hoc analysis ,Internal Medicine ,Empagliflozin ,Medicine ,Humans ,030212 general & internal medicine ,Dapagliflozin ,Benzhydryl Compounds ,Canagliflozin ,Sodium-Glucose Transporter 2 Inhibitors ,Aged ,Advanced and Specialized Nursing ,business.industry ,Incidence ,Hazard ratio ,Middle Aged ,Treatment Outcome ,chemistry ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Female ,business ,Mace ,Diabetic Angiopathies ,medicine.drug ,Glomerular Filtration Rate - Abstract
OBJECTIVE The sodium–glucose cotransporter 2 inhibitors (SGLT2i) empagliflozin and canagliflozin reduce the incidence of major adverse cardiovascular events (MACE), all-cause mortality (ACM), and renal events in cardiovascular outcomes trials, with observational real-world evidence suggesting class effect benefits that include dapagliflozin. We examined the placebo arm of the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) to determine whether the effects of drop-in open-label dapagliflozin on MACE, ACM, and estimated glomerular filtration rate (eGFR) were consistent with the SGLT2i class as a whole. RESEARCH DESIGN AND METHODS SGLT2i drop-in therapy occurred in 10.6% of EXSCEL participants, with 5.2% taking dapagliflozin. Propensity-matched cohorts of SGLT2i users and nonusers (n = 709 per group) were generated on the basis of their characteristics before open-label SGLT2i drop-in or at baseline for participants taking SGLT2i at enrollment and an equivalent study visit for non-SGLT2i users. Time to first adjudicated MACE and ACM was analyzed using Cox regression. eGFR slopes were compared between matched cohorts using a mixed-model repeated-measures analysis. RESULTS In adjusted analyses, SGLT2i users (compared with nonusers) had a numerically lower risk of MACE (adjusted hazard ratio 0.79 [95% CI 0.49–1.28]), as did dapagliflozin users (0.55 [0.26–1.15]). SGLT2i users had a significantly lower ACM risk (0.51 [0.27–0.95]; dapagliflozin: 0.66 [0.25–1.72]). Compared with nonusers, eGFR slope was significantly better for SGLT2i users overall (+1.78 [95% CI 0.87–2.69] mL/min/1.73 m2 per year) and for dapagliflozin users (+2.28 [1.01–3.54] mL/min/1.73 m2 per year). CONCLUSIONS This post hoc analysis of the placebo arm of EXSCEL supports a beneficial class effect for all SGLT2i, including dapagliflozin, for reduced ACM and less eGFR decline.
- Published
- 2019