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Microvascular and Cardiovascular Outcomes According to Renal Function in Patients Treated With Once-Weekly Exenatide: Insights From the EXSCEL Trial.
- Source :
-
Diabetes care [Diabetes Care] 2020 Feb; Vol. 43 (2), pp. 446-452. Date of Electronic Publication: 2019 Nov 22. - Publication Year :
- 2020
-
Abstract
- Objective: To evaluate the impact of once-weekly exenatide (EQW) on microvascular and cardiovascular (CV) outcomes by baseline renal function in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).<br />Research Design and Methods: Least squares mean difference (LSMD) in estimated glomerular filtration rate (eGFR) from baseline between the EQW and placebo groups was calculated for 13,844 participants. Cox regression models were used to estimate effects by group on incident macroalbuminuria, retinopathy, and major adverse CV events (MACE). Interval-censored time-to-event models estimated effects on renal composite 1 (40% eGFR decline, renal replacement, or renal death) and renal composite 2 (composite 1 variables plus macroalbuminuria).<br />Results: EQW did not change eGFR significantly (LSMD 0.21 mL/min/1.73 m <superscript>2</superscript> [95% CI -0.27 to 0.70]). Macroalbuminuria occurred in 2.2% of patients in the EQW group and in 2.5% of those in the placebo group (hazard ratio [HR] 0.87 [95% CI 0.70-1.07]). Neither renal composite was reduced with EQW in unadjusted analyses, but renal composite 2 was reduced after adjustment (HR 0.85 [95% CI 0.74-0.98]). Retinopathy rates did not differ by treatment group or in the HbA <subscript>1c</subscript> -lowering or prior retinopathy subgroups. CV outcomes in those with eGFR <60 mL/min/1.73 m <superscript>2</superscript> did not differ by group. Those with eGFR ≥60 mL/min/1.73 m <superscript>2</superscript> had nominal risk reductions for MACE, all-cause mortality, and CV death, but interactions by renal function group were significant for only stroke (HR 0.74 [95% CI 0.58-0.93]; P for interaction = 0.035) and CV death (HR 1.08 [95% CI 0.85-1.38]; P for interaction = 0.031).<br />Conclusions: EQW had no impact on unadjusted retinopathy or renal outcomes. CV risk was modestly reduced only in those with eGFR ≥60 mL/min/1.73 m <superscript>2</superscript> in analyses unadjusted for multiplicity.<br /> (© 2019 by the American Diabetes Association.)
- Subjects :
- Aged
Cardiovascular Diseases epidemiology
Cardiovascular Diseases prevention & control
Cardiovascular System drug effects
Cause of Death
Diabetes Mellitus, Type 2 complications
Diabetes Mellitus, Type 2 epidemiology
Diabetes Mellitus, Type 2 physiopathology
Female
Glomerular Filtration Rate drug effects
Humans
Kidney physiopathology
Male
Microvessels drug effects
Microvessels physiopathology
Middle Aged
Risk Factors
Survival Analysis
Treatment Outcome
Diabetes Mellitus, Type 2 drug therapy
Diabetic Angiopathies epidemiology
Diabetic Angiopathies prevention & control
Exenatide therapeutic use
Kidney drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1935-5548
- Volume :
- 43
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Diabetes care
- Publication Type :
- Academic Journal
- Accession number :
- 31757838
- Full Text :
- https://doi.org/10.2337/dc19-1065